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DENTAL  MATERIA  MEDICA 
THERAPEUTICS 


J  n 


PRESCRIPTION  WRITINC 


BY 


ELI  H.  LONG,  M.D. 


PROFESSOR    OF    DENTAL   MATERIA    MEDICA   AND    THERAPEUTICS  IN    THE    DENTAL   DEPART- 
MENT, EMERITUS  PROFESSOR  OP    MATERIA    MEDICA    AND    THERAPEUTICS    IN    THE 
MEDICAL    DEPARTMENT,   PROFESSOR    OF    TOXICOLOGY    IN    THE    PHARMACY 
DEPARTMENT,  UNIVERSITY  OF    BUFFALO;    CONSULTING    PHYSICIAN 
TO    THE    BUFFALO    GENERAL    HOSPITAL 


FOURTH  EDITION,  THOROUGHLY  REVISED 


LLUSTRATED  WITH    FOURTEEN    ENGRAVINGS  AND 
EIGHTEEN    COLORED    DIAGRAMS 


LEA  &  FEBIGER 

PHILADELPHIA    AND    NEW    YORK 


Copyright 

LEA   &   FEBIGER 

1920 


TO 

THE   MEMORY   OF 

WILLIAM  T.  G.  MORTON,  M.D. 

WHO   FIRST 
MADE   KNOWN   SURGICAL   ANESTHESIA   BY 

ETHER 

AND   TO   WHOM   THE 

PROFESSIONS   OF   MEDICINE    AND   DENTISTRY,    AND   THE   WORLD,    OWE 

A   DEBT   OF   PERPETUAL   GRATITUDE, 

THIS  VOLUME 

IS   DEDICATED 


PREFACE  TO  FOURTH  EDITION. 


While  progress  in  medical  science  as  applied  to  dentistry  has  required 
a  thorough  revision  of  the  text,  the  original  aim  of  the  author  to  adapt 
the  book  particularly  to  the  needs  of  the  dental  student,  has  been 
adhered  to.  The  chapters  on  Analgesia  and  Anesthesia  have  been 
largely  rewritten,  also  the  article  on  Syphilis,  and  a  new  chapter  on 
Animal  Drugs  has  been  added,  all  of  which  necessitated  enlargement 
by  twenty-five  pages.  Doses  have  been  generally  included  in  the  text, 
the  average  U.  S,  P.  dose  being  employed  for  official  substances,  while 
the  range  of  permissible  dosage  for  all  internal  drugs  is  given  in  the 
Index  of  Drugs. 

The  author  expresses  his  appreciation  of  the  great  assistance  rendered 
by  his  friend,  the  late  William  H.  Lane,  B.S.,  M.D.,  D.D.S.,  who  care- 
fully revised  the  chapters  on  Local  Remedies. 

The  courtesy  and  patience  of  the  publishers  is  likewise  acknowledged, 
since  much  delay  on  the  author's  part  in  completing  the  revision  was 
occasioned  by  a  period  of  ill-health. 

E.  H.  L. 

Buffalo,  N.  Y.,  1920. 


^' 


CONTENTS. 

PART   I. 

INTRODUCTION 17 

CHAPTER  I. 
Drugs  and  Medicines:  Their  Constituents  and  Preparations       ...       21 

CHAPTER  II. 
Remedies:  Their  Classification  and  Definitions 36 

CHAPTER  III. 
Administration  of  Medicines       41 

CHAPTER  IV. 
Modes  of  Action  of  Medicines 50 

PART   11. 

LOCAL  REMEDIES. 

CHAPTER  V. 
Depletives 55 

CHAPTER  VI. 
Counterirritants 59 

CHAPTER  VII. 

Escharotics 70 

(vii) 


viii  CONTENTS 

CHAPTER  VIII. 
Demulcents  and  Emollients 90 

CHAPTER   IX. 
Astringents  and  Hemostatics 94 

CHAPTER  X. 
Detergents,  Antacids  and  Alkalies 115 

CHAPTER  XI. 
Antiseptics '     .      .      .     124 

CHAPTER  XII. 
Bleaching  Agents 159 

CHAPTER  XIII. 
Anesthetics.     Local  Analgesics 164 


PART   III. 

GENERAL  REMEDIES. 

CHAPTER  XIV. 
Anesthetics 185 

CHAPTER  XV. 
Stimulants  and  Tonics 217 

CHAPTER  XVI. 
Alteratives 2.32 

CHAPTER  XVII. 
Sedatives    . 238 


CONTENTS  ix 

CHAPTER  XVIII. 
Eliminatives 249 

CHAPTER  XIX. 
Animal  Drugs 253 

CHAPTER  XX. 
Dextistrt  during  Pregnancy 256 


PAET   IV. 

CHAPTER  XXI. 
Prescription  Writing 261 

CHAPTER  XXII. 

Poisons 289 

Table  of  Poisons  and  Antidotes 291 


Index  of  Drugs 297 

General  Index 327 


DENTAL  MATERIA  MEDICA,  THERAPEUTICS 
AND  PRESCRIPTION  WRITING. 


PART  I. 
INTRODUCTION. 


The  need  of  a  book  on  Materia  Medica  and  Therapeutics,  prepared 
especially  for  the  specialist  in  dentistry,  indicates  a  certain  distinctness 
of  practice  that  does  not  apply  to  other  specialties.  The  general  text- 
book on  this  branch  is  all  that  is  wanted  by  the  general  surgeon,  the 
ophthalmologist,  the  gynecologist,  and  in  fact  by  all  specialists  whose 
preparation  includes  a  complete  medical  course  of  study.  Whether  we 
regard  the  condition  as  normal  or  not,  the  fact  is  apparent  that  the  prac- 
tice of  dentistry  today  has  too  little  in  common  with  general  medicine. 
This  is  likely  to  be  true  to  a  degree  for  the  future  also,  even  though 
the  tendency  now  is  to  broaden  the  curriculum  of  dental  colleges.  The 
relation  of  mouth  conditions  to  the  health  of  the  whole  body  has  in 
recent  years  assumed  an  importance  that  calls  for  a  broader  training 
of  the  dental  specialist,  so  that  he  may  be  able  to  stand  upon  common 
ground  with  the  physician  in  solving  the  problems  that  present  them- 
selves. The  preparation  for  special  practice  cannot  be  too  broad  as 
to  principles,  but,  at  the  same  time,  there  is  a  practical  limit  to  the 
detail  of  general  medicine  that  can  profitably  enter  into  the  dental 
student's  undergraduate  work. 

The  matter  entering  into  these  chapters  is  written  from  a  standpoint 
that  recognizes  the  need  of  a  special  text-book,  but  that  also  realizes  the 
narrowing  tendency  that  inevitably  attends  the  supplying  of  that  need. 
The  author,  therefore,  makes  no  apology  for  attempting  to  illustrate 
by  diagrams,  with  explanatory  text,  the  action  of  the  most  important 
internal  drugs  upon  the  general  system,  nor  for  the  somewhat  extensive 
treatment  of  classes  of  remedies  and  preparation  of  drugs. 
2 


18  INTRODUCTION 

Certain  general  terms  require  definition  or  comment  at  the  outset. 

The  term  remedy  inchides  any  agent,  of  whatever  character,  employed 
in  the  treatment  of  disease.  A  remedy  is  not  necessarily  a  substance; 
it  may  be  some  external  force  or  simply  an  influence. 

A  medicine  is  any  substance  administered  or  applied  in  the  treatment 
of  disease. 

The  term  drug  is  inclusive,  meaning  any  substance  used  in  the  com- 
position of  medicines  or  entering  into  chemical  processes,  or  any  poison. 

Materia  medica,  in  a  restricted  sense,  means  the  materials  or  substances 
used  in  medicine.  In  a  broad  sense,  the  term  means  the  science  of 
drugs  in  their  varied  relations,  i.  e.,  their  sources,  properties,  prepara- 
tions and  uses. 

Pharmacy  is  the  science  of  preparing  medicines  for  use.  It  includes 
not  only  the  making  of  drug  preparations,  but  also  the  art  of  compound- 
ing and  dispensing  medicines. 

Pharmacology  has  had  much  the  same  meaning  as  materia  medica  in 
its  broad  sense,  but  it  has  more  recently  come  to  be  applied  to  a  distinct 
part  of  the  science  of  drugs,  that  which  treats  of  the  action  of  drugs  upon 
the  tissues,  organs  and  functions  of  the  body. 

Therapeutics  is  the  science  and  art  of  employing  remedies  in  the 
treatment  of  disease.  While  therapeutics  should  have  a  scientific  basis 
in  the  knowledge  of  the  action  and  effects  of  remedies,  practical  treat- 
ment of  disease  will  alwaj^s  remain  an  art,  because  of  the  many  modifying 
factors  that  render  scientific  precision  impos^^ible. 

Toxicology  is  that  part  of  medical  science  which  treats  of  poisons.  It 
includes  the  nature  and  effects  of  poisons,  their  doses,  their  detection, 
and  the  treatment  of  the  conditions  resulting  from  poisoning. 

As  a  standard  for  the  purity  and  uniformity  of  drugs  and  prepara- 
tions, we  have  the  volume  known  as  the  United  States  Pharmacopoeia,* 
which  is  the  recognized  authority  for  this  country.  Other  countries 
have  similar  standards.  The  book  does  not  treat  of  the  action  or  uses 
of  medicines,  but  it  furnishes  a  list  of  recogn  ized  drugs,  with  descriptions, 
tests  of  purity,  etc.,  and  of  preparations,  with  their  formulas.  The 
drugs  and  preparations  so  recognized  are  called  "official."  An  average 
dose  is  given  of  each  drug  and  preparation  used  internally.     This  book, 

*  The  IT.  S.  Pharmacopa ia  was  first  issued  in  1820.  It  is  sul)je('ted  to  revision 
every  ten  years.  It  is  not  issued  by  the  Government,  as  is  the  case  with  the  phar- 
macopa'ias  of  most  countries,  but  it  is  authorized  by  the  professions  of  medicine 
and  pharmacy.  A  convention,  representing  medical  and  pharmaceutical  colleges 
and  associations,  meets  once  in  ten  years  in  the  city  of  Washington,  for  the  purpose 
of  directing  its  revision,  wliich  is  accomplished  through  a  committee  of  revision. 


INTRODUCTION  .  19 

being  our  authority  upon  drugs  and  their  preparations,  forms  the  basis 
of  our  text-books  on  materia  medica,  pharmacy  and  therapeutics.  It 
is  revised  every  ten  years  under  direction  of  the  professions  of  medicine 
and  pharmacy.  The  abbreviation  (U.  S.  P.)  always  indicates  this 
work. 

A  Dispensatory  is  a  comprehensive  text-book  on  materia  medica.  It 
has  been  called  a  commentary  upon  the  Pharmacopoeia ;  but  it  is  more 
than  this,  in  that  it  treats  of  a  vast  number  of  substances  that  are  not 
official,  and  discusses  also  the  uses  of  drugs.  But  it  is  not  an  authorized 
work  as  is  the  Pharmacopoeia. 

The  National  Formulary  (X.  F.)  is  a  very  important  collection  of 
formulas  that  are  not  official,  but  which  are  in  common  use.  It  is  pre- 
pared under  the  direction  of  the  American  Pharmaceutical  Association, 
and  is,  therefore,  in  a  sense  authoritative. 

In  the  study  of  the  practical  values  and  uses  of  remedies  we  employ 
several  related  terms  which  are  too  often  confused.  Physiologic  action, 
physiologic  effect  and  therayeutic  effect  are  terms  distinct  in  meaning, 
and  they  should  be  properly  understood.  The  action  and  effect  of  a 
drug  cannot  always  be  the  same.  The  action  may  be  obscure;  the 
effect  must  be  apparent.  To  illustrate:  Tincture  of  iodine  applied 
in  a  case  of  pericementitis  has  its  action  upon  the  mucous  membrane 
where  applied,  but  the  jjhysiologic  effect  that  we  desire  is  alteration  of 
the  disturbed  circulation  in  the  pericementum.  Again,  we  may  have 
physiologic  action  and  physiologic  effect  without  therapeutic  effect,  the 
latter  depending  upon  a  relief  of  symptoms.  In  the  above  condition 
the  therapeutic  effect  would  be  relief  of  the  pain;  but  the  inflammation 
might  be  so  severe  that  our  therapeutic  effect  would  not  follow. 

The  actio?!  of  a  drug,  then,  consists  of  a  change  of  conditions,  chemic, 
thermic,  electric  or  structural,  which  determines  an  alteration  of  func- 
tion. This  alteration,  when  apparent,  is  known  as  the  effect  of  the 
drug.  Within  the  limits  of  normal  function  this  effect  is  physiologic, 
while  a  disturbance,  or  depression  beyond  the  normal,  is  a  toxic  effect. 
When  the  action  is  in  the  direction  of  restoring  normal  conditions,  the 
effect  is  usually  a  relief  of  symptoms  of  disease,  and  is  called  the  thera- 
peutic effect.  We  may  have  the  action  and  the  physiologic  effect  of  a 
drug  in  a  normal,  healthy  individual,  but  never  the  therapeutic  effect. 

Some  drugs  may  cause  unpleasant  or  undesirable  effects  aside  from 
their  main  action.  These  are  called  untoivard  effects,  and  their  avoid- 
ance calls  for  discrimination  in  administration  and  dosage.  Closely 
related  is  the  matter  of  susceptibility  to  drug  action,  some  individuals 


20  INTRODUCTION 

being  very  sensitive  to  the  influence  of  a  certain  drug  and  readily 
showing  untoward  effects  of  the  same.  On  the  other  hand,  tolerance 
to  certain  drugs  may  be  acquired  by  continued  use,  so  that  very  large 
quantities  may  be  taken  without  dangerous  results.  The  habit  drugs, 
particularly  morphine  and  cocaine,  exhibit  this  fact;  victims  of  habitual 
use  of  either  often  being  able  to  take  many  times  the  poisonous  dose. 

A  cumulative  effect  is  sometimes  seen  with  slowly  acting  drugs,  par- 
ticularly when  elimination  is  faulty.  The  successive  doses  given  accu- 
mulate and  their  full  action  is  likely  to  be  excessive,  disturbing  or  poison- 
ous. Digitalis  is  a  drug  which  needs  care  in  its  use  to  avoid  cumulative 
effect. 

As  related  to  the  emplo^Tnent  of  remedies,  the  term  indication  means 
the  symptom  or  condition  that  calls  for  a  particular  remedy  or  course 
of  treatment,  while  contra-indication  means  the  condition  or  symptom 
that  forbids  the  use  of  a  certain  remedy  or  method.  A  symptom  is  an 
evident  disturbance  or  alteration  of  function  or  structure,  which  is  the 
expression  of  disease.  A  sign  is  a  symptom  or  phenomenon  that  is 
positive  evidence  of  some  particular  disease.  Diagnosis  means  the 
determination,  by  means  of  s^Tnptoms  or  signs,  of  the  character  or  name 
of  the  disease,  while  prognosis  is  the  prediction  of  the  course  or  termina- 
tion of  the  same. 

The  term  resolution  indicates  the  changes  in  diseased  tissues  toward 
the  normal,  and  means  structural  recovery.  Dissolution,  on  the  con- 
trary, means  death.  The  term  specific  has  tw^o  meanings.  Applied  to 
a  remedy,  it  means  that  the  remedy  can  be  invariably  relied  upon  to 
produce  a  therapeutic  effect  in  a  certain  disease,  as  quinine  in  malarial 
fever  or  antitoxin  in  diphtheria;  but  when  we  speak  of  specific  disease 
we  mean  syphilis.  The  term  is  thus  used  among  physicians  to  desig- 
nate, in  a  way  that  cannot  give  offence,  that  disease  that  in  its  true 
name  has  the  stigma  of  vice  attached  to  it. 


CHAPTER   I. 

DRUGS  AND  MEDICINES:  THEIR  CONSTITUENTS  AND 
PREPARATIONS. 

The  terms  dnig  and  medicine  are  not  strictly  sjoion^Tnous,  although 
popularly  so  regarded.  Both  mean  material  substances,  therefore  they 
exclude  such  agents  as  heat,  light  and  electricity.  The  term  medicine 
implies  use  in  the  treatment  of  disease,  while  the  classes  of  drugs  include 
many  substances  that  are  known  usually  as  chemicals  and  that  are  never 
used  directly  in  treatment.     Therefore: 

A  medicine  is  any  substance  administered  or  applied  in  the  treatment 
of  disease. 

A  drug  is  any  substance  used  in  the  composition  of  medicines  or  in 
chemical  processes. 

A  yoisonous  drug  is  one  which  is  capable  of  causing  a  disturbance  of 
function,  or  disease,  or  death.  Poisons  must  be  included  among  drugs, 
but  in  their  poisonous  quantities  they  cannot  be  medicines,  although  a 
substance  that  in  a  large  dose  is  a  poison  may  in  a  smaller  dose  be  a 
medicine.     Poisons  are  discussed  in  greater  detail  in  a  separate  chapter. 

The  term  remedy  is  more  inclusive  than  the  term  medicine,  meaning 
any  agent  (whether  a  substance,  a  force,  or  any  influence  whatever) 
employed  in  the  treatment  of  disease.  In  another  chapter  occurs  the 
classification  and  discussion  of  remedies. 

Drugs  are  classified  variously:  in  respect  of  their  sources,  as  vegetable 
drugs,  mineral  drugs  and  animal  drugs;  regarding  their  constitution, 
as  organic  and  inorganic;  and  respecting  their  uses,  as  medicinal  and 
chemical  drugs. 

In  the  development  of  the  science  of  drugs,  the  beginning  had  to  be 
with  two  quite  distinct  groups  of  substances — the  simple  chemicals,  or 
chemical  elements  as  we  now  know  them,  such  as  zinc,  mercury  and 
iron,  and  the  more  complex  organic  vegetable  drugs,  such  as  opium, 
cinnamon  and  ipecacuanha.  The  chemical  elements,  as  a  rule,  were 
found  to  possess  comparatively  slight  medicinal  value  while  in  their 
simple  form,  and  except  for  their  power  of  chemical  combination  would 
have  remained  of  little  use.     Their  great  value,  therefore,  depends  upon 


22  DRUGS  AND  MEDICINES 

the  large  number  of  useful  combinations  which  they  form.  To  illus- 
trate: ]\Iercury  or  quicksilver  in  its  pure  form  is  insoluble  and  non- 
medicinal,  but  combined  with  chlorine  in  a  certain  proportion  it  yields 
calomel  (HgCl),  a  valuable  cathartic;  and  in  another  proportion  it 
yields  corrosive  sublimate  (HgCl2),  a  powerful  antiseptic;  again,  it  may 
be  combined  with  sulphur  to  produce  a  ^-aluable  red  coloring  agent 
known  as  vermilion  (HgS).  An  almost  endless  \'ariety  of  combinations 
among  the  eighty-three  chemical  elements  now  known,  provides  a  field 
from  which  we  draw  many  agents  used  in  dentistry,  with  a  limitless 
future  as  to  new  compounds. 

]\Iuch  of  both  scientific  and  commercial  energy  is  being  expended  in 
the  synthesis,  or  putting  together,  of  chemicals  in  order  to  secure  new 
valuable  compounds.  The  products  are  often  referred  to  as  synthetics. 
Phenacetin  and  saccharin  are  examples  of  this  class.  Remarkable  also 
it  is,  that,  besides  new  products,  many  of  the  active  principles  originally 
obtained  from  organic  drugs  are  now  produced  s^^lthetically  in  the 
laboratory.  Salicylic  acid,  artificial  oil  of  wintergreen,  and  even  phenol, 
furnish  examples  of  such. 

In  strong  contrast  to  the  above,  the  other  group,  the  organic  drugs, 
besides  being  of  use  in  their  crude  form,  lend  themselves  to  division 
and  analysis  rather  than  to  combination.  They  are  complex  in  their 
composition,  therefore  one  organic  drug  may  contain  from  one  to  a 
dozen  or  more  distinct  substances  of  medicinal  value.  These  are  called 
crmstituents ,  active  imnciples  or  proximate  principles  of  the  drug.  For 
example,  opium,  the  juice  of  the  unripe  seed-capsule  of  the  opium  poppy, 
contains  gum,  albumin,  sugar,  wax,  pectin,  salts,  caoutchouc,  acids 
and  at  least  twenty  alkaloids,  among  which  are  morphine  and  codeine. 
The  most  important  work  being  now  done  upon  these  complex  drugs 
is  that  of  isolating  their  active  principles  or  constituents  in  a  state  of 
purity  and  stability;  and  when  a  single  principle  is  found  to  represent 
the  drug  fully  it  is  commonly  used  in  its  stead. 

We  have,  therefore,  in  the  rational  grouping  of  drugs : 

1.  The  chemical  substances  and  their  elaborated  compounds. 

2.  The  organic  crude  substances  (of  vegetable  and  animal  origin) 
and  their  isolated  active  principles. 

PREPARATIONS    OF   DRUGS. 

Nearly  all  of  the  organic  and  many  chemical  drugs  are  not  in  proper 
form  for  administration  without  further  preparation,  hence  the  elabo- 


PREPARATIONS  OF  DRUGS  23 

ration  of  our  materia  medica  to  include  a  large  number  of  preparations 
which  represent  more  or  less  completely,  in  medicinal  value,  the  simple 
or  crude  substances. 

It  would  be  interesting  to  trace  the  development  of  pharmacy  in 
bringing  forth  the  different  kinds  of  preparations,  in  response  always 
to  definite  needs,  and  to  note  individual  characteristics  in  each  class; 
but  it  must  suffice  to  state  in  general  that  they  fulfil  needs  in  prepa- 
ration, such  as  solubility  and  permanency,  and  likewise  needs  in 
administration,  such  as  pleasant  form  and  taste,  definiteness  of  strength, 
external  uses,  etc. 

These  preparations  are  obtained  by  simple  solution  of  a  drug,  by 
extraction  of  its  active  principles,  or  by  incorporation  of  it  with  a  vehicle, 
the  objects  of  such  preparations  being  to  secure  the  medicine  in  a  suit- 
able form,  in  definite  strength,  and  in  a  permanent  or  stable  condition. 
Occasionally  chemical  action  is  employed,  but  the  larger  number  are 
produced  without  any  chemical  change  occurring  in  the  ingredients. 
The  preparations  produced  without  chemical  action  are  known  as 
galenical  preparations,  being  so  named  after  the  ancient  physician 
Galen. 

With  so  many  drugs,  furnishing  so  large  a  number  of  preparations, 
the  need  of  standards  of  identity,  purity,  strength,  etc.,  is  very  appar- 
ent.    Such  standards  are  provided  in  the  United  States  Pharmacopceia.* 

As  regards  strength  of  organic  drugs  the  amount  of  active  principle 
present  seemed  to  be  the  best  basis  for  standardization,  and  much 
progress  has  been  made  in  recent  years  in  establishing  processes  of 
assay  to  which  the  substances  must  conform.  Several  that  do  not 
admit  of  a  determinative  chemical  assay  are  now  tested  biologically. 
Tests  of  various  salts  and  chemicals  have  been  also  added,  so  that  now 
the  Pharmacopceia  gives  about  300  assays  of  drugs  and  preparations. 
This  contributes  ^'ery  much  to  definiteness  and  insures  greater  reliability 
and  accuracy  in  the  use  of  our  most  important  medicines. 

Among  all  of  the  classes,  the  fluidextracts  deserve  emphasis  as  the 
most  representative  preparations  of  the  crude  organic  drugs.  They 
are  so  prepared  as  to  contain  all  of  the  active  principles,  to  be  of  a  uni- 
form definite  strength,  and  to  keep  indefinitely.  The  tinctures  may  be 
regarded  as  equal  in  importance,  being  permanent  alcoholic  solutions 
of  drugs,  though  weaker  than  fluidextracts.  Syrups  present  the  drugs 
in   form   for   pleasant   administration,    as   also   do   pills   and   troches. 

*  See  page  18  and  footnote. 


24  DRUGS  AND  MEDICINES 

Plasters,  linimciits  and  ointments  illustrate  the  adaptation  of  drugs  to 
external  uses. 

The  A'arious  preparations  are  presented  in  the  folio ^ving  list,  arranged 
in  classes  alphabetically,  with  each  class  defined,  and  the  names  given 
of  the  most  important  ones,  or  those  of  interest  to  the  dental  specialist. 
The  names  given,  both  for  each  class  and  each  individual  preparation, 
are  those  employed  in  the  official  volume,  the  U.  S.  Pharmacopoeia. 

CLASSES    OF   OFFICIAL   PREPARATIONS. 

Acetum. — A  Vinegar.^ — A  solution  of  a  medicinal  substance  in  diluted 
acetic  acid.     Vinegars  have  an  acid  reaction. 

Acetum  S'cillse. 

Aqua. — A  Medicated  Water. — A  solution  of  a  volatile  substance 
in  water. 

*Aqua  ammonise  (10  per  cent.).  *Aqua  chloroformi  (about  0.5  per  cent. ) 

*Aqua  ammonia?  fortior  (28  per  cent.).  Aqua  cinnamomi. 

*Aqua  amj'gdalse  amarff.  Aqua  creosoti. 

Aqua  anisi.  Aqua  menthie  piperita?. 

A(iua  aurantii  florum.  Aqua  ros£e. 

Aqua  camphorae. 

Those  marked  thus  (*)  may  be  either  irritating  or  poisonous  when  used  freely. 
All  others  are  harmless,  being  used  mostly  as  flavoring  agents. 

Ceratum. — A  Cerate. — A  preparation  having  a  fatty  base  with  a 
melting  point  above  the  temperature  of  the  body. 

Ceratum.  Ceratum  cantharidis  (35  per  cent.). 

Cerates  are  used  only  for  local  medication  or  protection. 

Collodium.- — A  Collodion.^ — A  liquid  preparation  for  external  use, 
having  as  a  basis  a  solution  of  guncotton  in  a  mixture  of  ether  and 
alcohol. 

Collodium.  Collodium  flexile. 

Collodium  cantharidatum. 

CoUodia  are  employed  to  protect  or  to  constrict  tissue,  or  to  apply 
an  irritant  drug  to  the  skin.  Having  the  nature  of  a  varnish,  they 
cannot  be  applied  unless  the  surface  is  perfectly  dry.  They  dry  quickly 
by  evaporation  of  the  ether  and  alcohol. 

Decoctum.— A  Decoctiox.^ — A  liquid  preparation  made  by  boiling  a 
vegetable  drug  in  water.     Not  used  where  active  principle  is  volatile. 


CLASSES  OF  OFFICIAL  PREPARATIONS  25 

The  U.  S.  Pharmacopoeia  gives  a  general  formula  for  decoctions  of 
5  per  cent,  strength.  Unless  some  preservative  is  added,  they  do  not 
keep  well;  so  they  must  be  freshly  prepared. 

Elixir. — An  Elixir. — A  sweetened,  aromatic,  spirituous  preparation 
of  one  or  more  drugs,  designed  for  pleasant  administration. 
Elixir  aromaticum.  Elixir  glyc>Trliiz£e. 

Some  elixirs  are  used  only  as  vehicles,  their  alcoholic  character 
permitting  the  addition  of  fluidextracts  without  precipitation.  The 
National  Formulary  contains  the  formulas  of  a  large  number  of  elixirs 
for  the  administration  of  drugs  of  unpleasant  taste. 

Emplastrum. — A  Plaster. — A  solid  preparation  for  external  use, 
adhesive  at  the  temperature  of  the  body. 

Emplastrum  belladonnge.  Emplastrum  elasticum. 

Emplastrum  capsici.  *Emplastrum  ichthyocollse. 

Emplastrum  cantharidis.  Emplastrum  sinapis. 

These  are  usually  spread  upon  muslin  and  are  intended  for  protection 
to  the  skin,  or  for  the  application  of  either  irritating  or  sedative  drugs. 

Emulsum. — ^An  Emulsion. — A  liquid  preparation,  in  which   oil  or 

resinous  matter  is  held  in  suspension  in  water.   They  require  a  viscid  or 

mucilaginous- substance  in  order  to  effect  and  maintain  the  suspension 

of  the  insoluble  particles. 

Emulsum  amygdate.  Emulsum  olei  morrhuse  (cod-liver  oil). 

Emulsum  asafcetidae  (4  per  cent.).  Emvdsum  olei  terebinthinse. 

Emulsions  are  in  no  sense  solutions,  their  object  being  to  carry  sub- 
stances that  are  not  soluble  in  water.  In  case  of  asafoetida,  a  gum- 
resin,  there  is  sufficient  gum  in  the  drug  to  carry  the  resin,  so  that  the 
emulsion  is  formed  hy  rubbing  up  the  drug  with  water  only. 

Extractum.— An  Extract. — ^A  solid  or  semisolid  concentrated  prep- 
aration of  the  soluble  constituents  of  a  drug. 

Extractum  aconiti.  Extractum  glycyrrliizae. 

Extractum  beUadonnse  foUorum.  Extractiun  malti. 

Extractum  colocynthidis.  Extractum  nucis  vomicae. 

Extractum  ergotse.  Extractum  opii. 

The  object  of  this  class  is  chiefly  concentration  of  the  drug,  but  the 
keeping  qualities  are  usually  also  improved.  The  form  permits  of  their 
being  made  readily  into  pills,  or  of  ready  solution. 

Fluidextr actum. — A  FLriDEXTRACT. — An  alcoholic  or  hydro-alcoholic 
solution,  one  milliliter  f  of  which  represents  one  gram  of  the  crude 

*  Courtplaster,  an  exception  to  the  rule,  is  applied  with  moisture.     (Not  official.) 
t  Formerly  called  cubic  centimeter. 


26  DRUGS  AXD  MEDICINES 

drug.     [Acids  or  alkalies  are  sometimes  used  to  aid  in  the  extraction  of 

the  principles.] 

Fhudextractum  aconiti.  Fliiidextraetum  glycyrrhizae. 

Fluidextractum  aurantii  amari.  Fluidextractum  guaranae. 

Fluidextractum  belladonna:^  radicis.  Fluidextractum  hj-drastis. 

Fluidextractum  digitalis.  Fluidextractum  ipecacuanhse. 

Fluidextractum  ergotae.  Fluidextractum  nucis  vomicae. 

Fhiidextracts  constitute  the  most  representative  class  of  preparations, 
there  })ein.s    49  official.     Their  drug  strength  is  uniformly  100  per  cent. 

Glyceritum. — A  Glycerite. — A  solution  of  a  medicinal  substance  in 

glycerin. 

Glyceritum  acidi  tannici  (20  per  cent.).      Glyceritum  hydrastis  (100  per  cent.). 
Glyceritum  boroglycerini  (31  per  cent.   *Glyceritum  phenolis  (20  per  cent.), 
of  boric  acid). 

Infusum. — Ax  Infusion. — A  liquid  preparation  made  by  macerating 
a  vegetable  drug  in  hot  or  cold  water. 

Infasum  digitalis.  Infasum  sennge  compositum. 

There  is  also  a  general  formula  for  infusions  of  5  per  cent,  strength. 
These  preparations  do  not  keep  well.     Either  they  must  be  freshly- 
made  or  some  preservative  added. 

Linimentum. — A  Liniment. — A  liquid  preparation  for  external  use, 
usually  possessing  a  stimulating  or  sedative  property.  Liniments  vary 
much  in  character,  but  most  of  them  contain  some  oil  or  soap. 

Linimentum  ammoniae.  Linimentum  chloroformi  (.30  per  cent.). 

Linimentum  belladonnae.  Linimentum  saponis. 

Linimentum  calcis.     Carron  oil.  Linimentum  saponis  mollis. 

Linimentum     camphorae.     Camphor-  fLinimentum  terebinthinae  (35  per  cent.). 
ated  oil. 

Liquor. — A  Solution. — An  aqueous  solution  of  one  or  more  non- 
volatile substances,  [in  some  a  chemical  reaction  is  employed  to  obtain 
the  desired  product.] 

Liquor  arseni  et  hydrargyri  iodidi.  Liquor   iodi    compositus    (5    per    cent. 

Liquor  arseni  arsenosi  (1  per  cent.).  iodine).     Lugol's  solutioii. 

Liquor  calcis.     Lime-water.  Liquor  plumbi  subacetatis. 

Liquor  cresolis  compositus.  Liquor  potassii  arsenitis. 

Liquor  ferri  chloridi.  Liq.  potassii  hydroxidi  (4.5  per  cent.). 

Liquor  ferri  subsulphatis.     MonseVs  Liquor  sodae  chlorinatae  (2.5  per  cent. 

solution.  chlorine). 

Liquor  ferri  tersulphatis.  Liquor  sodii  arsenatis. 

Liquor  formaldehjdi.  Liquor  sodii  hydroxidi  (4.5  per  cent.). 

Liquor  hydrogenii  dioxidi  (3  per  cent.).  Liquor  zinci  chloridi  (50  per  cent.). 

*  Formerly  glyceritum  acidi  carbolici. 

t  Linimentum  terebintliina'  (tiu-pentine  liniment)  may  be  .semisolid. 


CLASSES  OF  OFFICIAL  PREPARATIONS  ,  ''*'  ''/.FT 

Massa. — A  Mass. — A  mixture  of  substances  of  the  proper  consistence 
to  be  made  into  pills. 

Massa  ferri  carbonatis.  Massa  hydrargj-ri.     Blue   -pill    (33  per 

cent.  m:rcur3'). 

Mistura. — A  ]Mixture. — An  aqueous  liquid  preparation  usualh'  hold- 
ing some  insoluble  matter  in  suspension. 

Mistura  cretge.  Mistura  glyc}Trhiza^  comp.     Broirn  mix- 

ture. 

Mucilago. — A  IMucilage. — A  solution  of  a  gum  or  vegetable  mucilage 
in  water.  ^Mucilages  are  used  as  demulcents,  or  as  excipients  in  various 
preparations. 

]Mucilago  acacise  (35  per  cent.).  Mucilago  tragacanthse. 

Oleatum. — Ax  Oleate. — A  solution  of  a  medicinal  substance  in  oleic 
acid.     Oleic  acid  here  contributes  a  superior  penetrating  quality. 

*01eatum  cocainse  (5  per  cent.).  *01eatum  veratrinse  (2  per  cent.). 

Oleatum  hydrargjTi  (25  per  cent.  ye\- 
low  oxide). 

Oleoresina. — Ax  Oleoresix. — X  liquid  or  semiliquid  mixture,  chiefly 
of  oil  and  resin,  extracted  from  the  drug  by  percolation  with  ether. 
[They  are  really  ethereal  extracts.] 

Oleoresina  aspidii.  Oleoresina  cubebse. 

Oleoresina  capsici.  Oleoresina  zingiberis. 

The  term  also  applies  to  certain  natural  products,  consisting  of 
mixtures  of  oil  and  resin,  which  occur  as  exudates  from  the  trees  con- 
taining them.     These  may  be  liquid  or  solid.     Examples  are: 

Copaiba  (Uquidj.  *  Terebinthina  (solid). 

Oleum. — Ax  Oil. — A  natural  compound  of  one  or  more  of  the  fatty 
acids  with  glycerin.  True  oils  and  fats  must  be  capable  of  saponifica- 
tioQ,  /.  e.,  forming  a  soap  when  treated  with  an  alkali.  They  vary  in 
consistence  and  in  melting  point,  chiefly  on  account  of  the  varying 
proportions  of  olein,  palmitin  and  stearin  which  they  contain.  They 
are  not  volatile.  They  occur  naturally  in  animal  tissues  and  in  the 
seeds  of  many  plants  and  trees. 

Oleum  amygdalae  expressum.  Oleum  olivse  {olive  oil). 

Oleum  gossypii  seminis.  Oleum  ricini  (castor  oil). 

Oleum  lini  {linseed  oil).  Oleum  tiglii  (croton  oil). 
Oleum  morrhuse  {cod-liver  oil). 

*  Not  official. 


2S  DRUGS  AND  MEDICINES 

The  solid  fats  are: 

Adeps  (lard).  Oleum  theobromatis  (cacao  butter). 

Adeps  lana?  (lanolin).  Sevum  pra^paratum  (suet). 

Spermaceti  and  wax  are  similar  to  these  in  that  they  are  saponifiable, 
but  they  contain  no  glycerin.  Petrolatum  (vaselin)  is  not  a  fat,  although 
it  may  be  used  as  a  basis  in  ointments. 

Oleum  Destillatum. — A  Distilled  Oil.  [Volatile  Oil.  Essential 
Oil.] — A  volatile,  oily  principle  usually  obtained  from  the  crude  drug 
b}^  distillation.  They  are  not  saponifiable,  therefore  they  are  not  true 
oils.  The  volatile  oils  are  usually  the  essential  principles  of  the  plants 
yielding  them.  It  will  be  noticed  that  many  of  them  are  obtained  from 
spices. 

*01eum  amygdalae  amara>  (bitter  almond) .    Oleum  limonis  (leino7i). 
Oleum  aurantii  (orange).  Oleum  mentha;  piperita?  (pepperminl). 

Oleum  cajuputi.  *01eum  sinapis  volatile  (mustard). 

Oleum  caryophylli  (cloies).  Oleum  terebinthinse  (turpentine). 

Oleum  cassiae  (oi7  of  ci?i?iamon).  Oleum  thymi. 

Oleum  eucalypti  (contains  eucalj-ptol). 
Oleum  gaultherise   (methyl  salicylate; 
oil  of  irintergreen) . 

Pilula. — A  Pill. — A  spherical  or  oval  mass,  containing  one  or  more 
medicinal  ingredients,  intended  to  be  swallowed  whole. 

Pilulse  (plur.)  aloes  (gr.  2  in  each).  Pilulse  ferri  carbonatis. 

Pilulae  asafoetida;  (gr.  3  in  each).  Pilulse  ferri  iodidi. 

Pilulse  catharticEC  compositse  (gr.  1  of  Pilulse  phosphori  (gr.  j^-^  in  each), 

calomel  included  in  each  pill).  Pilulse  rhei  compositse. 

The  chief  object  in  the  use  of  pills  is  to  avoid  the  unpleasant  taste  of 
medicines.  Sometimes,  however,  they  may  be  used  in  order  to  secure 
a  slow  or  delayed  absorption  of  the  medicine. 

Resina. — A  Resin. — A  solid  preparation  consisting  chiefly  of  resin- 
ous substances.  They  are  insoluble  in  water,  and  are  usually  obtained 
by  precipitation  from  tinctures  by  the  addition  of  water.  As  a  class 
resins  are  soluble  in  alcohol,  ether,  chloroform  and  oils.  They  soften 
with  the  aid  of  heat. 

Resina  (rosin).  Resina  podophylli. 

Resina  jalapse.  *      Resina  scammonise. 

*  These  do  not  exist  ready  formed  in  the  drug,  but  are  developed  when  the  drug  is 
moistened  with  water,  in  the  presence  of  which  a  reaction' between  certain  con- 
stituents occurs,  with  the  formation  of  the  volatile  oil.  This  process  must  precede 
distillation  in  case  of  these.  With  the  exception  of  these  two,  which  are  poisonous 
and  should  never  be  given  in  larger  dose  than  TTlJ  (0.03  gm.),  the  dose  of.  the  volatile 
oils  is  mi-5  (0.06-0.30  gm.). 


CLASSES  OF  OFFICIAL  PREPARATIONS  29 

GuM-RESixs  are  related  to  the  above,  but  differ  from  them  in  compo- 
sition and  solubility.  They  contain  a  gimi  associated  u^ith  the  resin; 
therefore  they  are  only  partly  soluble  in  ahohol  and  are  partly  soluble 
also  in  water.     The  two  most  important  ones  are: 

Asafoetida.  MjTrh. 

Balsamic  Resins  and  Balsams  also  belong  to  the  group  of  resinous 

substances.     They  are  characterized  by  the  presence  of  benzoic  or 

cinnamic  acid.     They  include : 

Benzoinum.  Balsamum  peru\'ianuin. 

Styrax.  Balsamum  tolutanum. 

Sapo. — ^A  Soap.- — An  alkaline  product  of  the  reaction  between  a 
fatty  acid  and  either  soda  or  potassa.*  Soaps  are  prepared  by  heating 
a  fat  or  oil  with  an  alkali — potassa  yielding  a  soft  soap  and  soda  a  hard 
soap. 

Sapo  {white  castile  soap).  Sapo  mollis  (soft  soap). 

Spiritus. — ^A  Spirit. — An  alcoholic  solution  of  a  volatile  substance. 

Many  of  the  spirits  are  prepared  from  the  volatile  oils. 

Spiritus  getheris  (32.5  per  cent.).  Spiritus  glycerylis  nitratis  (1  per  cent. 

Spiritus  aetheris  nitrosi.  nitroglycerin). 

Spiritus  ammonise  aromaticus.  Spiritus  lavandulae  (5  per  cent.  oil). 

Spiritus  anisi  (10  per  cent.  oil).  Spiritus  menthse  piperitse  (10  per  cent. 

Spiritus  camphorse  (10  per  cent.).  oil). 

Spiritus  chloroformi  (6  per  cent.).  Spiritus  myrcise  (bay  rum — not  official). 

SpiritiLS  cinnarnomi  (10  per  cent.  oil). 

Suppositorium.- — A  Suppository. — A  solid,  conical  mass,  containing 
one  or  more  medicinal  substances,  intended  for  introduction  into  some 
passage  or  cavity  of  the  body.  A  suppository  should  melt  readily  at 
the  temperature  of  the  body,  to  ensure  which  a  base  of  either  cacao 
butter  or  glycerinated  gelatin  is  commonly  employed.  The  size  may 
vary  from  15  to  60  grains  (grams  1  to  4).  The  U.  S.  P.  gives  general 
directions  for  their  preparation  with  either  base. 

They  are  made  of  different  shapes,  according  to  the  particular  use  for 
which  they  are  intended.  Those  for  introduction  into  the  urethra, 
often  called  bougies,  are  pencil  shaped,  while  for  rectal  and  vaginal  use 
they  are  conical  or  oval. 

The  following  is  exceptional  in  being  prepared  with  sodiiun  stearate 
as  a  base,  and  in  being  used  simply  as  laxative,  acting  by  local  irritation. 

Suppositoria  (plur.)  glycerini.  (These  contain  about  80  per  cent,  of  glycerin 
with  a  soap  for  a  base.) 

*  This  definition  is  a  restricted  one,  intended  to  define  the  official  soaps.  Chemi- 
cally speaking,  the  salt  of  a  fat  acid  with  any  inorganic  base  is  a  soap. 


30  DRUGS  AND  MEDICINES 

Syrupus. — A  Syrup. — An  aqueous  medicinal  solution  containing  sugar 
nearly  to  saturation.  [A  few  syrups  are  without  decided  medicinal 
value,  being  used  chiefly  as  vehicles.] 

Being  rather  thick  in  consistence,  they  may  hold  solid  particles  in 
suspension,  thus  possessing  added  value  as  excipients,  and  their  con- 
sistence also  gives  them  something  of  the  quality  of  demulcents.  As  a 
rule,  they  are  weaker  than  tinctures. 

Two  objects  are  secured  in  this  class  of  preparations — preservation 
and  pleasant  taste — both  of  which  are  due  to  the  large  amount  of  sugar 
present. 

Syrupus  (85  per  cent,  sugar).  Syrupus  pruni  virginianse. 

Syrupus  acaciiE.  Syrupus  rhei. 

Syrupus  acidi  citrici.  Syrupus  rhei  aromaticus. 

Syrupus  aurantii.  Syrupus  scillse. 

Syrupus  ferri  iodidi.  Syrupus  scillse  compositus. 

Syrupus  hypophosphitum.  Syrupus  tolutanus. 

Syrupus  ipecacuanhae.  Syrupus  zingil^eris. 

Syrupus  lactucarii. 

Tinctura. — A  Tincture. — An  alcoholic  or  hydroalcoholic  solution  of 

the  active  principles  of  a  crude  drug  or  of  a  non-volatile  substance. 

Tinctures  are  weaker  than  fluidextracts  and  have  no  uniform  strength 

as  a  class,  except  that  tinctures  of  potent  drugs  are  of  10  per  cent. 

strength. 

Tinctura  aconiti.  *Tinctura  iodi  (7  per  cent.). 

Tinctura  lielladonna'  foliorum.  Tinctura  kino. 

Tinctura  benzoini.  Tinctura  lavandula?  composita. 

Tinctura  benzcini  composita.  Tinctura  niyrrha^. 

Tinctura  cantharidis.  Tinctura  nucis  vomica^. 

Tinctura  capsici.  Tinctura  opii  (10  per  cent.). 

Tinctura  cinchonge.  *Tinctura  opii  camphorata  (0.4  per  cent. 

Tinctura  cinchona?  composita.  opium). 

Tinctura  cinnamomi.  Tinctura  opii  deodorati  (10  per  cent.). 

Tinctura  digitalis.  Tinctura  tolutana. 

Tinctura  ferri  chloridi.  Tinctura  veratri. 

Tinctura  gambir  composita.  Tinctura  zingiberis. 

Tinctura  gentiana;  composita. 

In  point  of  number  the  tinctures  hold  first  place,  there  being  54  official. 

Trituratio. — A  Trituration. — A  powder  consisting  of  a  potent  drug 
diluted  and  finely  divided  by  means  of  sugar  of  milk.     The  IT.  S.  P. 
gives  a  general  formula  for  the  preparation  of  10  per  cent,  triturations. 
The  following  is  the  only  official  one  named  separately : 
Trituratio  e'aterini. 

(See  Tablet  Triturates  following.) 

*  In  these  some  of  the  medicinal  constituents  are  quite  volatile. 


CLASSES  OF  OFFICIAL  PREPARATIONS  31 

Trochiscus. — Tabella. — A  Troche  or  Tablet. — A  solid  preparation 
in  tablet  form,  consisting  of  one  or  more  medicinal  substances  combined 
with  sugar  and  mucilage. 

Trochisci  (plur.)  acidi  tannici  (gr.   1  Trochisci  sodii  bicarbonatis    (nearly  gr. 

in  each).  3  in  each). 

Trochisci  ammonii  chloridi  (gr.  1|  in  Toxitabellse   hydrargyri   chloridi   corro- 

each).  sivi  (gr.  7i  in  each). 

Trochisci  cubebse  (Tn,  §  of  oleoresin  in 

each). 

Several  subdivisions  of  the  class  of  troches  must  now  be  recognized, 
some  of  which  do  not  conform  exactly  to  the  definition  given  above. 

Tablet  Triturates  combine  the  characters  of  the  trituration  and 
the  troche,  having  the  medicine  in  a  finely  divided  state  and  in  a  form 
pleasant  to  take.  A  great  variety  of  combinations  are  now  prepared 
in  this  form,  presenting  a  convenience  of  handling  and  of  administra- 
tion that  does  not  obtain  with  the  liquid  forms  of  medicine.  With 
some  drugs,  however,  the  fresh  liquid  preparations  are  more  reliable 
and  greatly  to  be  preferred. 

Hypodermic  Tablets. — For  h^'podermic  use  it  is  desirable  to  have 
the  medicine  readily  soluble,  therefore  the  tablet  should  contain  little 
or  nothing  besides  the  active  substance.  With  some  drugs  a  little 
mucilage  may  be  required  to  secure  adhesion  of  the  particles,  but  the 
least  possible  amount  should  be  used. 

Compressed  Tablets. — ^Many  substances  are  sufficiently  cohesive  to 
admit  of  being  compressed  into  tablet  form  without  the  addition  of 
any  adhesive  material.  Some  that  take  the  tablet  form  readily  do  not 
maintain  it  indefinitely.  They  may  be  deliquescent  and  become  soft 
or  even  liquid ;  or  they  may  be  efflorescent  and  become  dry  and  crumble. 
Such  will  require  to  be  kept  in  tightly-corked  bottles.  The  compressed 
tablets,  however,  are  very  convenient  and  usually  present  the  drug  in 
its  pure  form. 

Unguentum. — An  Ointment. — A  semisolid  fatty  preparation  for  ex- 
ternal use,  having  a  melting-point  near  the  temperature  of  the  bod}'. 

Unguentum  acidi  borici  (10  per  cent.).  Unguentum  hydrargyri  dilutum  (30  per 

Unguentum  acidi  tannici  (20  per  cent.).  cent.). 

Unguentum  aquae  rosfe.  Unguentum  iodi  (4  per  cent.). 

Unguentum  belladonnse  (10  per  cent.  Unguentum  phenolis   (2 J  per  cent,   of 

extract).  Uquefied  phenol). 

Unguentum  gallse  (20  per  cent.).  Unguentum  sulphur  is  (15  per  cent.). 

Unguentum  hydrargyri  (50  per  cent.).  Unguentum  zinci  oxidi  (20  per  cent.). 
Unguentum  hydrargyri  ammoniati  (10 

per  cent.). 


32  DRUGS  AND  MEDICINES 

Ointments  are  intended  to  protect,  soften  or  medicate  the  skin.  A 
few,  such  as  unguentum  hydrargyri,  are  used  for  the  purpose  of  sys- 
temic medication  by  being  rubbed  into  the  skin. 

CONSTITUENTS    OF   DRUGS. 

In  the  foregoing  hst  of  preparations  there  are  some  that  are,  as  well, 
simple  constituents.  This  is  true  of  the  oils,  the  distilled  oils  and  the 
resins,  these  being  obtainable  by  simple  means  in  a  fairly  pure  state, 
but  there  are  other  constituents  that  are  less  easily  separated  from  the 
drug,  but  which  are  usually  the  most  active  and  important  of  its  principles. 

As  we  study  the  value  of  an  organic  drug  in  its  desirable  medicinal 
effects,  it  is  evident  that  the  latter  must  be  dependent,  not  upon  the 
whole  drug,  but  upon  the  action  of  one  or  more  of  its  constituents  or 
proximate  principles;*  for  every  crude  drug  contains  inert  matter,  while 
some  have  constituents  of  undesirable  action.  It  is  important  to  know 
just  which  of  the  principles  are  medicinally  valuable;  and  where  such 
are  capable  of  isolation  there  is  evident  advantage  in  their  employment 
instead  of  the  preparations  of  the  whole  drug. 

Their  recognition  depends  upon  their  possessing  a  definite  chemical 
character  which  is  not  essentially  altered  in  the  process  of  extraction.* 

Since  the  recognition  of  morphine  in  opium  by  Setiirner,  in  1817, 
much  effort  has  been  expended  in  securing  the  active  principles  of  the 
various  drugs  in  a  state  of  purity  and  solubility  for  practical  use.  So 
successful  has  the  effort  been  with  many  of  our  leading  drugs  that  their 
quality  is  now  gaged  by  the  amount  of  active  principles  present,  e.  g., 
opium  cannot  be  official  unless  it  contains  9.5  per  cent,  of  morphine. 

Of  all  classes  of  active  constituents  the  alkaloids  and  the  glucosides 

are  most  important  and  distinct. 

.  Alkaloids. — These  are  defined  to  be  nitrogenous  compounds  of  organic 

origin,  having  the  reaction  and  basic  property  of  alkalies.  The  following 

are  some  of  the  most  prominent  alkaloids : 

Aconitine,  from  aconite.  Mori)hine,  from  opium. 

Atropine,  from  belladonna.  Narcotine,  from  opium. 

Caffeine,  from  tea,  coffee  and  guarana.       Nicotine,  from  tobacco. 

Cinchonine,  from  cinchona.  Pilocarpine,  from  pilocarpus. 

Cocaine,  from  coca  leaves.  Quinine,  from  cinchona. 

Codeine,  from  opium.  Scopolamine  or  hyoscine,  chiefly  from 

Emetine,  from  ipecacuanha.  hyoscyamus  and  stramoniimi. 

Hydrastine,  from  hydrastis.  Strychnine,  from  nux  vomiciE. 

Hyoscyamine,  from  hyoscyamus.  Veratrine,  from  asagra;a  officinalis. 

*  The  term  proximate  principle  is  defined  to  be  any  substance,  either  simple  or 
compound,  which  is  present  in  its  own  form  in  the  drug,  as  proven  by  its  being 
capable  of  extraction  without  change  of  its  chemical  properties. 


CONSTITUENTS  OF  DRUGS  ,  33 

Alkaloids  have  a  definite  chemical  composition.  Most  of  them  are 
crystallizable,  although  a  few  are  liquid,  e.  g.,  nicotine.  Most  of  them 
are  bitter  to  the  taste,  some  intensely  so. 

The  pure  alkaloids,  as  a  rule,  are  nearly  insoluble  in  water,  but  their 
basic  character  permits  the  formation  of  salts  that  are  freely  soluble. 
For  example,  while  cocaine  requires  600  parts  of  water  to  dissolve  it, 
cocaine  hydrochloride  is  soluble  in  0.4  part  of  water,  or  1500  times  more 
soluble  than  simple  cocaine.  Therefore,  almost  without  exception, 
soluble  salts  of  alkaloids  are  used  instead  of  the  simple  substances. 
Double  salts  also  are  sometimes  employed. 

Alkaloids  usually  represent  much  or  all  of  the  activity  of  the  drugs 
containing  them,  and  it  is  believed  that  they  exist  in  the  drugs  only  in 
combination  with  acids.  This  has  been  proven  to  be  true  of  many  of 
them,  e.  g.,  morphine  exists  in  opium  in  combination  with  either  sul- 
phuric or  meconic  acid,  i.  e.,  as  sulphate  or  as  meconate  of  morphine; 
strychnine  is  combined  in  nux  vomica  with  igasuric  or  "strychnic" 
acid,  etc. 

As  a  class,  we  accord  alkaloids  the  preeminence  among  medicines. 
Their  action  is  chiefly  upon  the  nervous  system,  through  which  they 
may  exert  an  indirect  influence  upon  other  kinds  of  tissue.  They  have 
almost  no  influence  upon  elimination,  none  of  them  being  classed  among 
the  cathartics.  They  are  very  active  agents  in  comparatively  small 
medicinal  doses,  and  many  of  them  are  poisonous  to  the  nervous  system 
when  given  in  large  doses.  Because  of  smallness  of  dose,  ready  solu- 
bility, and  the  fact  that  they  are  not  irritating  to  tissues,  as  a  rule,  most 
of  their  salts  may  be  used  hypodermically.  They  furnish  our  most 
powerful  narcotics  and  anodynes.  Two  especially,  morphine  and  cocaine, 
present  the  danger  of  drug  habit  through  unguarded  or  continued  use. 

In  some  drugs  these  principles  are  very  numerous.  Opium  and 
cinchona,  for  instance,  each  yield  twenty  or  more  alkaloids. 

Artificial  Alkaloids.- — Besides  the  large  number  of  alkaloids  existing 
naturally,  a  number  of  others  have  been  produced  artificially,  usually 
by  subjecting  a  natural  one  to  chemical  change.  Some  of  these  arti- 
ficial bodies  are  valuable  additions  to  the  list,  as  they  are  found  in  some 
instances  to  have  an  action  quite  distinct  from  that  of  the  original 
alkaloid. 

The  principal  artificial  alkaloids  are : 

Apomorphine,  from  morphine.  Ethylmorphine  (dionin),  from  morphine. 

Betaeucaine  (eucaine),  from  piperidine.     Homatropine,  similar  to  atropine. 

Cotarnine  (stypticin),  from  narcotine.       Hydrastinine,  from  hydrastine. 

Diacetyhnorphine  (heroine),  from  Novocaine,  a  synthetic  product, 

morphine. 
3 


34  DRUGS  AND  MEDICINES 

Incompatibility  of  Alkaloids. — Drugs  are  said  to  be  incompatible 
with  each  other  when  their  mixture  results  in  an  undesired  physical  or 
chemical  change.  In  using  either  natural  or  artificial  alkaloids  we  must 
have  in  mind  their  incompatibility  with  certain  other  substances,  as 
given  below: 

1.  JJlth  Alkalies. — The  basic  power  of  the  alkaloids  is  exceeded  by 
that  of  the  ordinary  alkalies,  therefore  the  latter  easily  decompose 
the  salts  of  the  former.  Hence,  it  may  be  stated  that  alkaloidal  salts 
in  solution  are  incomjjatible  7cith  alkalies  and  alkaline  carbonates,  the 
mixture  leading  to  precipitation  of  the  alkaloid.  The  danger  here  is 
from  the  deposited  drug,  which  might  be  taken  in  poisonous  quantity 
in  the  last  one  or  two  doses  of  the  mixture. 

2.  With  Tannic  Acid.- — Alkaloids  unite  with  tannic  acid  to  form  tan- 
nates,  which  are  insoluble;  therefore,  alkaloids  and  their  salts  in  solution 
are  incompatible  with  tannic  acid  or  ^^  ith  any  preparation  containing  it, 
the  mixture  resulting  in  a  deposit  of  the  tannate  of  the  alkaloid.* 

3.  ]\ith  Metallic  Salt^. — Certain  metallic  salts,  especially  double  salts 
or  double  iodides,  cause  precipitation  when  mixed  \A"ith  alkaloidal 
solutions.  Lugol's  solution  also  will  precipitate  the  salts  from  solu- 
tion. 

Ptomaines  and  Leukomaines. — Two  other  classes  of  bodies  belonging 
to  the  group  of  organic  bases,  but  which  are  in  no  sense  medicines, 
should  be  mentioned  here  because  of  their  similarity  to  the  vegetable 
alkaloids.  They  are  ytomaiiies,  or  putrefactive  alkaloids,  which  are  basic 
substances  produced  by  the  action  of  bacteria  upon  organic  matter, 
and  leukomaines,  which  are  basic  substances  resulting  from  normal 
tissue  metabolism.  The  former  are  of  special  interest  as  contributing 
to  the  toxicity  of  many  bacterial  diseases,  and  from  the  resemblance 
of  certain  of  them  in  their  action  to  the  vegetable  alkaloids.  Thus, 
tetanine,  present  in  the  disease  tetanus,  or  lockjaw,  produces  the  char- 
acteristic spasms  of  this  disease,  which  resemble  closely  those  pro- 
duced by  strychnine.  Others  are  narcotic  in  action,  bearing  some 
resemblance  to  morphine  or  atropine. 

Glucoides. — This  class  comprises  those  vegetable  proximate  prin- 
ciples which,  when  decomposed  by  boiling  with  acids  or  alkalies,  or  by 

*There  seein.s  to  be  a  contradiction  to  the  above  in  the  fact  that  a  number  of 
vegetable  drugs  contain  both  tannic  acid  and  alkaloids,  without  any  'precipitation 
occurring  in  their  liquid  preparations.  The  explanation  of  this  is  that  the  alkaloid 
is  present  in  a  natural  combination,  which  is  not  broken  up  by  the  peculiar  tannic 
acid  that  is  its  natural  associate  in  the  particular  drug;  or  the  alkaloid  may  be  in 
natural  combination  with  the  tannic  acid. 


CONSTITUENTS  OF  DRUGS  35 

the  action  of  ferments,  yield  glucose,  with  some  other  product  peculiar 
to  the  substance  tested.  Some  have  the  chemical  behavior  of  acids, 
while  some  resemble  resins  in  nature. 

Neutral  principles  are  somewhat  similar,  but  ha\'e  neither  alkaline 
nor  acid  properties. 

These  two  classes  form  a  group,  some  members  of  which  are  of  great 
value  in  medicine.  Santonin,  aloin,  glycATrhizin,  amygdalin,  digitalin, 
and  elaterin  furnish  examples.  While  their  uses  are  varied,  the  activity 
of  many  of  them  is  addressed  to  the  eliminative  functions.  Especially 
do  we  find  them  in  the  cathartic  drugs.  As  a  class  they  influence  the 
nervous  system  less  than  do  the  alkaloids,  and  they  are  less  poisonous. 


CHAPTER   II. 
REMEDIES:  THEIR  CLASSIFICATION  AND  DEFIXITIOXS. 

The  term  remedy  includes  any  agent,  of  whatever  character,  employed 
in  the  treatment  of  disease.  It  may  be  a  medicine  or  an  external  force 
or  influence.  It  may  be  intended  for  internal  administration,  for 
external  application,  or  for  less  direct  mental  influence.  Remedies 
are  usually  grouped  as  follows: 

Preventive  remedies,  those  that  are  employed  to  prevent  the  acqui- 
sition, development,  or  propagation  of  disease,  e.  g.,  vaccination  to 
prevent  smallpox,  and  disinfection  to  pre^'ent  the  spread  of  any  infec- 
tious disease. 

Since  it  has  become  known  that  all  infectious  diseases  are  preventable, 
this  group  has  attained  a  rank  of  first  importance. 

Hygienic  remedies,  those  that  conduce  to  the  maintenance  of  health 
and  of  good  resistive  power  against  the  causes  of  disease.  They  include 
proper  food,  ventilation,  exercise,  bathing,  etc. 

This  group  is  closely  related  to  the  preceding  and,  on  the  whole, 
stands  next  to  it  in  importance,  it  being  a  sound  principle  that  such 
natural  means  of  preventing  or  correcting  diseased  conditions,  when 
efficient,  should  be  held  as  preferable  to  artificial  medicinal  or  mechani- 
cal means. 

Mechanical  remedies,  those  that  involve  the  application  of  mechanical 
principles  or  appliances,  e.  g.,  restraint,  the  use  of  splints,  bandages  and 
surgical  instruments. 

Imponderable  remedies  include  forces  or  influences  that  are  not  material 
in  nature,  e.  g.,  heat,  electricity,  sunlight. 

Medicinal  or  pharmacologic  remedies,  the  substances  administered  or 
applied  in  the  treatment  of  disease.  They  are  known  as  medicines. 
They  are  intended  to  directly  modify  functions,  or  to  antagonize  the 
process  of  disease,  or  remove  its  results.  Being  material  in  nature,  they 
form  the  basis  of  pharmacology,  or  the  study  of  the  action  of  medicines. 

Our  classification  will  concern  this  group  chiefly,  and  will  be  based 
upon  action  and  uses,  rather  than  the  sources  of  the  various  substances. 


CLASSIFICATION  OF  REMEDIES 


37 


REMEDIES    . 


Classification  of  Remedies. 

Local. 
General. 


Local  Remedies 


Depletives. 

Rubefacients. 

Vesicants. 

Escharotics. 

Demulcents. 

Emollients. 

Astringents. 

Hemostatics. 

Detergents. 

Antacids  (alkalies). 

Antiseptics. 

Bleaching  agents. 

Analgesics. 


Stimulants  (tonics) 


Alteratives. 


Arterial  stimulants 


Nerve  stimulants 


[  Digestive  stimulants. 


Diffusible. 

Cardiac. 

Vascular. 

Cerebral. 

Spinal. 

Vasomotor. 


Sedatives 


General  Remedies    >  Antispasmodics. 


f  Cardiac. 
[Arterial  sedatives         |  Vascular. 


IAnodjmes. 
Hypnotics. 
Narcotics. 
I  Anesthetics. 
I  Antipyretics. 


Eliminatives 


Antiseptics. 

Antitoxins. 

Vaccines. 

Digestants. 

Anthelmintics. 


[  Nerve  sedatives 


Errhines. 

Sialagogues. 

Emetics. 
<*  Expectorants. 

Diaphoretics. 

Diuretics. 
.  Cathartics. 


38       REMEDIES:  THEIR  CLASSIFICATION  AND  DEFINITIONS 

DEFINITIONS. 

Local  Remedies. 

Depletive. — The  class  of  local  depletives  includes  the  various  means 
employed  to  abstract  blood  or  serum  from  an  inflamed  or  hy])eremic 
area. 

Scarification,  leeching  and  cupping  are  the  common  means. 

Rubefacient. — An  agent  that  produces  redness  of  the  skin. 

Vesicant  or  Epispastic. — An  agent  that  produces  a  blister. 

Escharotic  or  Caustic. — An  agent  that  destroys  tissue. 

The  terms  rubefacient,  vesicant  and  escharotic  may  represent  the 
different  degrees  of  action  of  the  same  agent  in  some  instances. 

Demulcent. — An  agent  that  protects  or  soothes  a  raw,  irritated  or 
inflamed  surface.  It  is  usually  an  oily,  mucilaginous  or  albuminous 
substance  that  directly  coats  over  the  surface,  but  it  may  be  an  agent 
that,  upon  a  mucous  surface,  stimulates  the  natural  secretion,  which 
itself  acts  as  a  demulcent. 

Emollient. — An  agent  that  softens  and  soothes  an  inflamed  part. 

Poultices  and  ointments  are  the  typical  emollients. 

Astringent. — An  agent  that  causes  contraction  of  tissue. 

Hemostatic. — An  agent  employed  to  arrest  hemorrhage.  Besides  the 
astringents,  thermal  and  mechanical  agencies  are  included. 

Detergent. — An  agent  used  to  cleanse  surfaces,  wounds  and  ulcers. 

Antacid. — An  agent  capable  of  neutralizing  acids,  by  reason  of  either 
its  alkaline  or  basic  property. 

Antiseptic  (Local). — An  agent  that  prevents  the  growth  and  propaga- 
tion of  septic  bacteria. 

Antiseptics,  germicides  and  disinfectants  form  a  related  group  which 
will  be  differentiated  in  connection  with  their  detailed  discussion. 

Bleaching  agents  include  the  agents  and  means  employed  to  remove 
discoloration  of  tooth  structures. 

Analgesic. — An  agent  that  destroys  sensibility  to  pain. 

General  Remedies. 

Stimulant. — An  agent  that  increases  the  activity  of  an  organic  function 
or  process. 

The  action  of  stimulants  is  temporary  and  tends  to  exhaustion  of 
reserve  energy. 


DEFINITIONS  39 

Tonic. — An  agent  that  restores  one  or  more  lacking  elements  to  the 
tissues,  or  promotes  their  nutrition,  or  conserves  their  reserve  energy. 

Alterative. — ^An  agent  that  counteracts  a  morbid  state  of  tissue  by 
altering  in  a  favorable  manner  the  processes  of  nutrition.  The  action 
is  usually  obscure. 

Alteratives  become  intimately  associated  with  the  tissue  elements 
during  their  stay  in  the  system;  they  act  slowly  and  influence  the  ^dtal 
processes. 

Sedative. — ^An  agent  that  diminishes  the  activity  of  an  organic  func- 
tion or  process. 

Anodyne. — An  agent  that  relieves  pain. 

An  anodjTie  may  depress  sensory  nerve  endings,  or  lessen  conductivity 
of  nerve  fibers,  or  diminish  the  receptivity  of  brain  centers. 

Hypnotic. — An  agent  that  induces  sleep. 

Narcotic. — ^An  agent  that  produces  stupor. 

The  same  agent  may  be  anodyne  or  h}'pnotic  in  moderate  dose  and 
narcotic  in  large  dose. 

Anesthetic. — ^An  agent  that  abolishes  all  sensation. 

Antipyretic. — An  agent  that  causes  reduction  of  temperature  in  fever. 

Antispasmodic. — An  agent  that  relieves  spasm  or  convulsion. 

The  term  simply  describes  one  effect  of  medicines  that  may  be  stimu- 
lating or  sedative  in  their  general  action. 

Errhine  or  Sternutatory. — An  agent  that  increases  the  secretion  of  the 
nasal  mucous  membrane.  The  latter  term  refers  especially  to  agents 
that  cause  sneezing. 

Sialagogue  or  Ptyalagogue. — An  agent  that  increases  the  secretion  of 
saliva. 

Emetic. — An  agent  that  causes  evacuation  of  the  stomach. 

Expectorant. — ^An  agent  that  increases  the  secretion  of  the  air  passages. 

Diaphoretic  or  Sudorific. — An  agent  that  induces  sweating. 

Diuretic. — An  agent  that  increases  the  excretion  of  urine. 

Diuretics  may  act  through  the  circulation  by  increasing  arterial 
pressure  or  modifying  the  composition  of  the  blood,  or  by  directly 
stimulating  the  activity  of  the  kidneys. 

Cathartic. — ^An  agent  that  causes  evacuation  of  the  intestinal  tract. 

Antiseptic  (General). — An  agent  that,  being  absorbed,  renders  fluids 
or  tissues  of  the  body  destructive  of,  or  resistant  to  the  growth  of, 
bacteria  or  other  parasitic  bodies. 

Antitoxin. — ^A  serum  that  possesses  the  power  to  neutralize  the  toxic 
product  of  the  bacteria  of  some  particular  disease. 


40       REMEDIES:  THEIR  CLASSIFICATION  AND  DEFINITIONS 

Vaccine. — A  substance  used  by  inoculation  or  injection  for  the  pur- 
pose of  securing  immunity  to  some  disease. 

Digestant. — An  agent  that  aids  the  sohition  and  preparation  of  foods 
for  absorption. 

Anthelmintic. — An  agent  that  destroys  intestinal  parasites. 

The  same  agent  may  be  a  vermifuge,  the  latter  term  referring  to 
expulsion  of  the  parasites. 


CHAPTER   III. 
ADMINISTRATION  OF  MEDICINES. 

It  is  a  sound  principle  in  medicine  that  the  more  nearly  a  remedial 
substance  can  be  applied  to  the  point  of  disease,  the  more  effectual 
and  the  safer  is  its  use.  In  accordance  with  this,  our  remedies  should 
be  applied  locally  as  far  as  possible.  The  site  of  the  disease,  therefore, 
will  determine  in  very  many  cases  the  selection  of  the  site,  avenue  or 
method  of  application  of  a  medicine.  The  urgency  of  a  condition 
also  will  demand  a  choice  of  method,  as  an  emergency  often  calls  for 
the  most  rapid  administration  that  is  possible.  We  recognize  various 
avenues  and  methods  by  which  medicines  are  introduced  to  the  system, 
and  these  require  separate  discussion. 

By  the  Stomach. — Stomach  or  mouth  administration  is  the  original 
and  common  method  employed  for  the  great  majority  of  medicines. 
As  the  stomach  and  intestine  constitute  the  natural  avenue  of  absorp- 
tion of  food  substances,  it  is  the  one  that  most  easily  provides  for  solu- 
tion and  absorption  of  a  medicine,  and  the  one  that  is  most  tolerant 
of  the  introduction  of  an  unusual  substance. 

It  should  be  noted  that  absorption  is  more  active  from  the  small 
intestine  than  from  the  stomach;  also  that  fluids  begin  to  pass  from  the 
stomach  into  the  intestine  very  soon  after  being  swallowed. 

A  very  soluble  drug  that  requires  only  a  small  dose  may  be  placed 
under  the  tongue,  and  absorption  follows  quickly.  Nitroglycerin  given 
in  this  way  will  produce  its  general  effect  within  three  minutes.  It  is, 
however,  a  very  diffusible  drug. 

Form  of  Medicine. — The  substance  employed  should  be  in  a  soluble 
condition,  or  in  solution,  if  intended  for  absorption  into  the  blood. 
For  local  effect  in  the  stomach  insoluble  medicines  are  frequently  used, 
e.  g.,  bismuth  subnitrate. 

The  reaction  of  the  gastric  juice  is  acid;  that  of  the  intestinal  juices 
is  alkaline;  thus,  the  solution  of  any  substance  soluble  in  either  an 
acid  or  alkaline  fluid  is  aided.  We  find  that  practically  any  substance 
that  is  even  slightly  soluble,  whatever  its  form  when  swallowed,  will 
in  time  find  its  way  into  the  fluids  of  the  body;     Solution  and  absorp- 


.42  ADMINISTRATION  OF  MEDICINES 

tion  are  sometimes  aided  by  chemical  change,  as  in  the  case  of  iron, 
which  is  changed  to  chloride  of  iron  by  union  with  the  hydrochloric  acid 
of  the  gastric  juice.  Some  substances  that  require  an  alkaline  liquid  to 
dissolve  them  may  pass  through  the  stomach  unchanged.  This  is  true 
of  salol,  which  is  insoluble  either  in  water  or  in  an  acid  liquid.  It 
reaches  the  small  intestine  unchanged,  where  it  is  soon  decomposed 
and  absorbed. 

Rapidity  of  effect  depends  upon  soluhiliti/  and  rate  of  ahsorytum. 
Quinine  sulphate  given  in  powder  form  will  require  considerable  time 
for  solution,  on  account  of  its  slight  solubility  except  in  the  presence 
of  a  free  acid. .  It  will  probably  require  the  secretion  of  considerable 
gastric  juice  to  dissolve  a  full  dose  of  this  drug;  therefore,  when  given 
in  powder,  an  hour  or  two  will  elapse  before  the  effect  is  appreciated. 
The  same  drug  given  in  solution  will  produce  its  effect  much  sooner, 
particularly  if  it  be  given  when  the  stomach  is  empty.  The  rate  of 
absorption  depends  somewhat  upon  the  diffusibility  of  the  medicine 
used,  but  all  of  the  conditions  that  modify  osmosis  have  their  influence; 
the  activity  of  the  circulation,  the  state  of  blood-pressure,  difference  in 
specific  gravity  or  degree  of  salinity  between  the  stomach  contents  and 
the  blood,  and  the  physical  character  of  the  substance  to  be  absorbed, 
must  all  have  their  influence.  Fats  and  oils  before  they  can  be  absorbed 
require  to  be  saponified,  which  change  occurs  after  they  pass  into  the 
duodenum.     Therefore,  they  are  not  absorbed  at  all  from  the  stomach. 

Among  all  of  the  above-named,  the  one  condition  modifying  the  rate 
of  absorption,  that  is  best  appreciated  and  most  easily  controlled,  is 
the  degree  of  dilution  of  the  drug  by  the  stomach  contents  which  must 
be  absorbed  with  it.  Thus,  if  the  dose  be  given  upon  an  empty  stomach, 
with  only  sufficient  fluid  to  ensure  its  solution  and  proper  dilution, 
absorption  should  occur  quickly,  say  in  half  an  hour;  while  the  same 
dose  given  after  a  full  meal  would  require  three  to  four  hours  for  com- 
plete absorption,  because  of  its  dift'usion  through  a  quart  or  more 
of  stomach  contents  which  need  that  length  of  time  for  absorption. 
In  the  latter  case  only  a  part  of  the  dose  would  be  taken  up  from  the 
stomach,  as  the  contents  with  which,  it  is  mixed  pass  gradually  into 
the  duodenum,  from  which  absorption  continues. 

It  follows  that,  in  order  to  produce  a  certain  degree  of  effect,  a  larger 
dose  will  be  needed  when  given  ivith  a  full  stomach  than  if  given  before 
a  meal,  for  the  degree  of  effect  depends  usually  upon  the  amount  of 
the  drug  circulating  in  the  blood  at  one  time.  This  amount  will  be 
determined  by  the  quantity  absorbed  within  a  certain  period,  minus 


BY  THE  BOWEL  43 

the  quantity  eliminated  during  the  same  period.  With  absorption 
slow  and  elimination  active  (the  elimination  of  some  drugs  begins  very 
quickly),  the  amount  present  in  the  blood  at  one  time  may  be  much 
less  than  the  amount  administered. 

As  a  rule,  then,  medicines  will  produce  their  effects  with  a  minimum 
dose  and  in  the  shortest  time  (one-half  to  one  hour)  when  given  with 
the  stomach  empty.  But  some  drugs  are  too  irritating  to  be  placed 
in  an  empty  stomach.  These  will  require  great  dilution.  This  is  true 
of  many  of  the  salts,  which  diffuse  easily,  as  a  rule,  and  may  be  given 
with  considerable  water.  Salts  as  irritating  as  the  bromides  and  iodides 
should  never  be  given  without  first  being  dissolved  and  well  diluted. 

When  rapidity  of  action  is  unimportant,  as  with  tonics  and  altera- 
tives, we  may  as  well  give  them  after  meals;  except  that  bitter  tonics, 
whose  action  is  a  local  one  upon  the  gastric  mucous  membrane,  should 
be  given  ten  or  fifteen  minutes  before  meals,  in  order  to  obtain  their 
best  effect.  Cathartics  are  commonly  given  at  bedtime  so  as  to  pro- 
duce their  effect  at  about  the  time  of  the  usual  m.orning  evacuation. 

Saline  cathartics  form  a  distinct  class  of  medicines  in  relation  to 
stomach  administration,  in  that  absorption  is  not  necessary  to  their 
action.  If  given  in  concentrated  solution  upon  an  empty  stomach 
their  high  degree  of  salinity  (high  osmotic  pressure)  will  determine  a 
flow  of  fluid  from  the  blood  into  the  digestive  tract  with  prompt  and 
copious  watery  evacuations.  They  are  best  ^iven  in  the  morning  upon 
arising,  as  a  prompt  effect  from  a  smafler  dose  may  be  thus  obtained 
than  when  given  at  evening  after  a  meal. 

By  the  Bowel  (Rectum  and  Colon). — Whenever,  on  account  of 
inability  to  swallow  or  persistent  vomiting,  stomach  administration  is 
impossible,  medicines  or  food  may  be  introduced  into  'ths  lower  bowel. 
Also  for  local  medication  of  the  rectum  or  other  organs  located  in  the 
pelvis,  as  in  cases  of  dysentery  or  of  hemorrhoids,  this  method  may  be 
our  first  choice. 

Form  of  Medicine. — The  rectum  does  not  provide  for  solution  of  sub- 
stances to  any  degree.  Therefore,  if  our  object  be  general  medication 
we  must  ensure  solution  of  our  drug.  But  if  we  desire  local  medication 
only,  then  absorption  into  the  general  circulation  is  unnecessary,  and, 
indeed,  may  be  undesirable;  so  we  may  have  our  drug  in  a  condition 
to  be  taken  up  slowly  by  the  tissues,  the  action  being  correspondingly 
prolonged.  For  general  effect  a  non-irritating  solution  should  be  used 
in  moderate  or  small  quantity,  so  that  it  may  not  be  expelled.  In  order 
to  favor  retention  and  absorption,  it  is  advantageous  to  place  the  dose 


44  ADMIXISTRATIOX  OF  MEDICINES 

high  up  in  the  colon.  This  can  be  done  with  a  patient  in  the  recum- 
bent posture,  by  raising  the  hips  above  the  level  of  the  head.  For 
local  effect  a  solution  or  suppository  may  be  employed. 

Rapidity  of  Effect.^ — For  general  effect  the  action  of  a  medicine  by 
rectal  administration  is  slower  than  by  the  stomach;  but  with  condi- 
tions unequal — i.  e.,  comparing  absorption  from  a  full  stomach  with 
absorption  from  an  empty  rectimi  we  may  have  a  more  rapid  effect 
from  the  rectmn.  It  is  usually  held  to  be  true  that  the  drugs  which 
act  upon  the  nervous  system,  e.  g.,  narcotics,  may  be  given  in  a  much 
larger  dose  by  the  rectum  with  safety.*  This  may  be  due  partly  to 
slow  absorption  and  partly  to  the  distance  from  vital  centers  of  the  site 
of  absorption.  A  safe  rule  for  most  substances  seems  to  be  that  the 
dose  iwr  rectum  may  be  twice  the  dose  yer  orem. 

In  addition  to  medication  it  is  common  practice,  after  severe  surgical 
operations,  to  supply  water  to  the  system  by  rectum.  An  approved 
method  is  the  INIurphy  method,  by  which  fluid  is  introduced  drop  by 
drop,  no  more  rapidly  than  the  system  absorbs  it,  and  continued  for 
hours  or  even  days. 

By  the  Skin. — ^^Ve  distinguish  several  methods,  as  follows: 

Epidermic,  uhere  a  substance  is  applied  to  the  surface  of  the  skin  for 
the  purpose  of  local  medication  or  of  counterirritation.  When  a  s^'s- 
temic  effect  is  desired  a  similar  application  may  be  made,  with  friction 
added,  to  secure  penetration  into  the  skin.  Thus  mercurial  ointment 
is  very  commonly  employed  in  the  treatment  of  s^-philis.  The  term 
inunction  is  applied  to  the  use  of  ointments  in  this  way. 

Endermic,  an  obsolete  method,  which  consisted  in  first  raising  a 
blister,  then,  after  removal  of  the  epidermis,  in  sprinkling  a  medicine 
intended  for  absorption  upon  the  raw  surface. 

Hypodermic. — This  method  has  assumed  an  importance  which  places 
it  next  to  stomach  administration.  For  promptness  of  action  and 
definiteness  of  dose  it  is  superior  to  all  other  methods,  in  the  use  of 
those  drugs  which  admit  of  its  emplo}7nent.  Also,  on  account  of 
rapidity  of  absorption,  the  dose  may  usually  be  about  one-half  of  the 
dose  by  the  stomach.  The  method  consists  of  the  introduction  of  the 
medicine  into  the  subcutaneous  tissue  bv  means  of  a  small  s^sTinge 


*  Contrary  to  this,  it  is  sometimes  stated  that  strychnine  is  more  poisonous  when 
injected  into  the  rectum  than  when  swallowed.  (Potter's  Materia  Medica,  1901, 
p.  391.)  It  is  true  that  adrug  absorbed  from  the  lower  part  of  the  rectum  will  pass 
directly  into  the  internal  iliac  vein  and  reach  the  heart  and  general  circulation 
without  passing  through  the  hver,  where  its  toxicity  might  be  lessened. 


BY  THE  SKIN  45 

armed  with  a  hollow  needle,  through  which  the  injection  occurs.  The 
pain  of  insertion  of  the  needle  deters  from  the  use  of  this  method  for 
ordinary  medication,  and  the  dangers  attending  the  injection,  though 
slight,  should  require  the  greatest  care  in  employing  it.  As  a  rule,  this 
method  "u  ill  find  its  place  in  meeting  the  following  conditions : 

1.  Inability  to  swallow,  as  when  unconscious,  or  after  local  injury. 

2.  Anj^  condition  requiring  the  immediate  action  of  a  medicine,  or 
absolute  certainty  of  dosage. 

3.  Inability  of  the  stomach  to  receive  or  retain  the  required  medicine. 

4.  Conditions  needing  local  medication,  as  in  the  emplo^mient  of 
cocaine.  In  dental  practice  the  injection  method  is  well  adapted  to 
the  need  of  securing  local  analgesia  in  many  cases  of  extraction.  A 
very  short  needle  is  here  employed  and  the  injection  is  submucous. 

The  hypodermic  and  submucous  injection  methods  are  limited  to 
the  use  of  soluble,  non-irritating  drugs.  Stimulation,  the  relief  of  severe 
pain  and  the  production  of  local  analgesia  comprise  the  common  indi- 
cations. The  freely  soluble  alkaloidal  salts  in  aqueous  solution  are 
well  adapted,  but  alcoholic  solutions  are  irritating.  Tinctures  are 
inferior  on  this  account,  but  they  may  be  used  in  emergency. 

The  dangers  attending  hypodermic  or  submucous  injection  are: 

1.  Septic  infection. 

2.  Injection  of  air  into  a  vein. 

3.  Injection  of  medicine  into  a  vein,  which  might  mean  an  overdose. 
Septic  infection  may  be  due  to  lack  of  sterilization  of  the  needle  or 

of  the  solution  employed.  The  result  is  usually  formation  of  abscess. 
To  avoid  this  danger  the  needle  and  syringe  should  be  sterilized  (by 
boiling  if  possible),  and  the  solution  be  in  boiled  or  distilled  water  and 
freshly  made. 

The  injection  of  air  into  a  vein  would  cause  interference  ^ith  the 
circulation  through  the  lungs.  The  air,  being  carried  to  the  right  side 
of  the  heart,  would  be  beaten  up  with  the  blood  into  a  foam,  by  the 
action  of  the  tricuspid  valve.  The  air  bubbles  thus  formed  would  not 
pass  through  the  pulmonary  capillaries;  hence,  the  occurrence  of  embar- 
rassment which  might  be  serious,  the  condition  being  known  as  air 
embolism.  An  animal  may  easily  be  killed  by  injecting  a  moderate 
quantity  of  air  into  one  of  its  veins. 

To  avoid  this  danger  the  syringe  should  always,  before  injecting,  be 
held  with  the  needle  upward,  gently  tapped  so  as  to  dislodge  any  air 
bubbles  within  and  cause  them  to  rise  toward  the  needle,  and  the 
plunger  then  gently  forced  onward  until  all  air  has  escaped  through 


46  ADMINISTRATION  OF  MEDICINES 

the  needle.  The  presence  of  a  Httle  air  in  the  subcutaneous  tissue  would 
usually  be  harmless,  the  danger  being  in  the  possibility  of  puncturing 
a  small  vein  and  forcing  air  therein.  With  this  possibility  is  connected 
the  next  danger,  that  of  overdose  caused  by  thro\\ing  the  whole  quantity 
of  the  drug  directly  into  the  venous  system.  Our  dose  is  intended 
for  gradual  absorption  into  the  blood  during  a  period  of  from  five  to 
fifteen  minutes.  If,  instead,  the  whole  dose  is  thrown  immediately 
into  the  blood  current  and  carried  to  the  central  nervous  system,  with- 
out the  possibility  of  free  dilution,  poisoning  may  quickly  occur.  To 
avoid  this  accident,  it  is  commonly  recommended  to  insert  the  needle 
deeply  enough  so  that  it  may  be  withdrawn  a  short  distance,  so  as  to 
escape  any  vein  that  might  have  been  punctured  in  its  course..  Another 
precaution  and,  in  the  writer's  opinion,  one  of  greater  certainty  is  to 
inject  slowly  and  note,  at  the  end  of  the  needle,  the  accumulation  of 
the  injected  fluid,  which  should  be  easily  felt  by  the  finger.  If  the  fluid 
disappears  about  as  rapidly  as  it  is  injected,  puncture  of  a  vein  should 
be  feared,  but  if  the  fluid  accumulates  with  the  injection,  so  that  a  dis- 
tinct swelling  is  felt  at  the  point  of  the  needle,  nothing  need  be  feared. 
With  the  injection  of  cocaine  into  the  gums  for  local  effect,  the  imme- 
diate blanching  of  the  tissue  about  the  point  of  the  needle  may  assure 
one  that  the  solution  has  diffused  into  the  tissues.  In  fact,  the  danger 
of  forcing  the  drug  into  a  vein  is  much  less  with  the  usual  submucous 
injection  than  with  the  hypodermic,  because  of  the  small  size  of  the 
veins  in  the  mucous  membrane  of  the  alveolar  region. 

The  Hypodermic  Sjrringe. — Many  kinds  of  syringes  are  on  the  market. 
The  older  style  of  glass  barrel  and  leather  plunger  syringe  has  the 
advantage  of  permitting  a  view  of  the  liquid  or  bubbles  of  air  within 
the  barrel,  but  the  disadvantage  of  being  less  easily  sterilized.  It  also 
dries  out  easily  unless  in  daily  use.  The  newer  style  of  all-metal  syringe 
has  the  disadvantage  of  allowing  no  view  of  the  interior,  but  it  has  the 
very  great  advantage  of  being  easily  sterilized  by  boiling  the  whole 
syringe.  Glass  syringes  are  now  also  used,  but  they  require  much  care 
in  handling.  W^ith  any  kind  the  needles  may  be  sterilized  by  boiling, 
while  a  thorough  cleansing  of  the  syringe  with  boiled  water  after  each 
use  and  frequent  washing  with  5  per  cent,  carbolic  acid,  followed  by 
alcohol,  will  be  sufficient  care  of  the  syringe.  The  needle  should  be 
thoroughly  sterilized  before  each  injection. 

How  to  Give  a  Hypodermic  Injection.— Having  syringe,  needle  and 
solution  sterile,  the  skin  is  best  cleansed  by  first  scrubbing  \Aith  soft 
soap  and  water,  then  sterilizing  by  the  application  of  50  to  70  per  cent. 


BY  THE  SKIN  47 

alcoholj  5  per  cent:  solution  of  carbolic  acid,  oil  of  turpentine,  1:1000 
solution  of  bichloride  of  mercurj^  or  some  other  equally  efficient  disin- 
fectant. The  hands  of  the  operator  should  be  similarly  treated.  ]Mak- 
ing  sure  of  the  absence  of  air  from  the  syringe,  the  latter  is  held  firmly 
with  the  right  hand  while  the  thumb  and  first  finger  of  the  left  hand 
grasp  the  skin  and  raise  it  slightly  at  the  point  selected.  Into  the  promi- 
nence thus  occasioned  the  needle  should  be  quickly  pushed  in  a  direc- 
tion nearly  horizontal  to  the  surface,  and  should  penetrate  to  the  depth 
of  from  one-third  to  one-half  an  inch  or  even  more.  It  may  be  with- 
drawn slightly,  so  as  to  disengage  the  point,  after  which  the  injection 
is  made  slowly  so  as  to  avoid  too  great  violence  to  the  tissues  by  rapid 
distention,  which  may  be  painful.  Diffusion  and  absorption  may  then 
be  aided  by  gentle  rubbing  over  the  injected  area. 

The  site  of  injection  for  general  systemic  efi^ect  may  be  upon  any 
accessible  portion  of  the  body,  care  being  taken  to  avoid  any  visible 
vein  or  the  proximity  of  an  artery  or  nerve  trunk;  but  in  case  of  col- 
lapse, when  the  circulation  and  activity  of  absorption  are  greatly 
reduced,  the  injection  should  be  made  upon  the  trunk  rather  than 
upon  the  extremities — i.  e.,  nearer  the  center  of  the  circulation,  so  as  to 
secure  more  rapid  absorption.  For  local  effect  the  site  of  injection 
admits  of  little  choice,  except  to  avoid  important  structures.  ^^Tien, 
however,  the  injection  is  for  local  analgesia  the  medicine  is  injected 
more  superficially,  directly  into  and  beneath  the  skin  or  mucous  mem- 
brane, the  object  here  being  to  paralyze  the  sensory  nerve  endings, 
which  are  more  abundant  superficial!}'.  It  is  unnecessary  to  penetrate 
deeply  into  the  tissue  unless  a  deep  operation  requires  it. 

A  word  of  caution  must  here  be  given  regarding  the  danger  of  form- 
ing the  habit  of  the  hj-podermic  use  of  narcotics,  especially  morphine 
and  cocaine.  This  particular  method  of  drug  addiction  is  more  com- 
mon than  is  usually  known.  The  seductive  effect  of  the  drug  is  so 
quickly  induced  that  the  victim  readily  endures  the  slight  pain  of  the 
injection  for  the  sake  of  the  agreeable  result.  It  becomes  the  dut}'  of 
every  practitioner  to  guard  his  patient  and  emphatically  himself  against 
this  danger.  Self-administration  of  a  narcotic  in  this  way  is  an  exceed- 
ingly dangerous  practice  and  must  never  be  encouraged. 

Cataphoresis.- — By  this  term  is  meant  the  introduction  of  drugs  in 
molecular  form  into  living  tissue,  by  means  of  the  galvanic  current. 
Analgesics  and  alteratives  may  be  employed  for  application  to  a  limited 
area  by  this  method.  The  positive  pole  applicator  is  saturated  with  a 
strong  solution  of  the  drug  and  placed  directly  over  the  part  to  be  medi- 


48  ADMINISTRATION  OF  MEDICINES 

cated,  the  negative  pole  being  placed  indifferently  upon  the  cutaneous 
surface,  but  avoiding  the  more  sensitive  tissue  of  the  face.  The  drug 
is  carried  from  the  positive  pole  into  the  tissue. 

This  method,  with  cocaine  as  the  drug,  has  been  used  to  allay  sensi- 
tiveness of  dentine.  Care  must,  however,  be  taken  not  to  disturb  the 
pulp  by  the  employment  of  a  strong  current — 5  to  10  volts  should  be 
the  maximum  strength  for  this  purpose.  It  is  also  employed  to  anes- 
thetize pulps  previous  to  immediate  extraction.  Further  uses  of  cata- 
phoresis  in  dentistry  are  to  carry  bleaching  agents  into  the  tubuli  of 
discolored  teeth  and  iodine  into  soft  tissues.  A  current  of  25  to  40 
volts  can  be  used  for  bleaching  purposes,  and  also  to  destroy  the  pulp 
of  a  tooth. 

It  has  been  recommended  to  cocainize  the  tissues  about  the  roots  of 
teeth  in  order  to  obtain  painless  extraction,  but  such  employment  of 
the  method  meets  with  little  practical  success. 

Intravenous  Injection. — In  case  of  emergency  it  sometimes  becomes 
necessary  to  inject  a  stimulating  or  restorative  agent  directly  into  a 
vein.  The  agent  most  used  for  this  purpose  is  the  physiologic  or  normal 
saline  solution  at  blood  temperature.  This  is  a  solution  of  8.5  parts 
of  sodium  chloride  in  1000  of  sterile  water.  It  corresponds  to  the 
blood  serum  in  salinity,  and  is  used  to  replace  the  latter  when  deficient, 
after  severe  hemorrhage  or  in  collapse. 

The  intravenous  method  has  come  to  be  employed  rather  extensively 
also  for  the  administration  of  salvarsan  in  syphilis  and  antitoxins  in 
diphtheria  and  tetanus.  The  effect  of  the  remedy  is  much  more  prompt 
and  efficient  when  thus  injected  directly  into  the  circulation. 

Hypodermoclysis.- — The  introduction  of  a  large  amount  of  normal 
saline  solution  is  most  commonly  accomplished  by  hypodermoclysis, 
or  injection  into  the  subcutaneous  cellular  tissue.  From  1  to  2  pints 
are  often  employed  once  or  twice  daily  for  a  number  of  days  in  succes- 
sion. The  indications  for  its  use  are  great  depression  from  acute  disease, 
hemorrhage  and  loss  of  fluid  from  the  system  by  severe  diarrhea.  The 
apparatus  employed  consists  of  a  gravity-  or  fountain-syringe  armed 
with  a  large-sized  hypodermic  needle.  The  latter  is  introduced  through 
the  skin  of  the  selected  site,  usually  the  lumbar  region  or  underneath 
the  breast,  and  the  fluid  is  allowed  to  flow  slowly  by  the  force  of  gravity 
into  the  loose  subcutaneous  tissue.  The  temperature  of  the  solution 
should  be  somewhat  higher  than  that  of  the  blood  so  as  to  allow  for 
cooling  during  the  slow  injection. 


BY  THE  LUNGS  49 

By  the  Lungs  (Inhalation). — Only  gases,  vapors  and  finely  atomized 
liquids  may  be  employed  by  inhalation.  The  method  is  limited  to  the 
use  of  anesthetics,  stimulants,  antiseptics  and  a  few  volatile  antidotes. 

Although  thus  limited,  it  is  the  most  rapid  of  all  methods  of  medica- 
tion. The  great  extent  of  surface,  especially  adapted  for  the  absorption 
of  gases,  presented  in  the  expansion  of  the  pulmonary  tract  (estimated 
at  1000  to  1400  square  feet)  explains  why  the  action  of  an  inhaled  gas 
or  vapor  is  felt  almost  immediately.  The  method  is  adapted  especially 
to  general  anesthesia  where  a  rapid  and  profound  effect  is  needed. 

For  practical  use  by  inhalation  a  vapor  must  be  non-irritating,  except 
when  stimulation  is  desired.  Ammonia  is  frequently  applied  by  inhala- 
tion in  case  of  fainting,  in  order  to  stimulate  the  heart  and  respiration. 
It  is  irritating  to  the  mucous  membrane,  and  by  this  action  it  produces 
reflex  stimulation. 

For  the  purpose  of  local  medication  of  the  air  passages,  antiseptics 
and  sedatives  are  frequently  vaporized  in  connection  with  steam. 
Either  the  steam  atomizer  may  be  used,  or  the  drug  may  be  placed 
upon  boiling  water,  from  which  the  steam  is  inhaled.  The  most  irri- 
tating cough  may  frequently  be  relieved  by  proper  medication  with  this 
method,  while  even  in  pulmonary  tuberculosis  the  local  treatment  by 
inhalation  is  now  given  an  important  place. 


CHAPTER  IV. 
MODES  OF  ACTION  OF  MEDICINES. 

The  precise  modes  of  action  of  all  drugs  upon  the  human  system  will 
probably  never  be  understood.  In  the  laboratory  many  medicines 
exhibit  certain  exact  physical  and  chemical  properties  that  are  constant; 
and,  while  a  knowledge  of  these  will  aid  us  very  much  in  studying  drug 
actions,  their  combination  with  biologic  factors  in  the  vital  structures 
of  the  body  brings  about  results  that  are  \'ariable,  often  indefinable, 
and  peculiar  as  to  individuals. 

This  topic  will  not  be  discussed  in  theoretic  detail;  but  the  simpler 
and  better  understood  modes  of  action  can  be  profitably  illustrated 
by  examples,  if  we  are  careful  to  remember  that  any  explanation  can 
only  be  partial  in  most  cases,  because  the  contributory  vital  factors  so 
commonly  defy  our  scrutiny. 

Physical  Action. — The  sunplest  kind  of  medicinal  action  is  that  where 
2)hysical  properties  alone  are  concerned.  Glycerin  applied  to  a  denuded 
surface  or  to  a  sensitive  mucous  membrane  furnishes  an  example  of 
such,  its  primary  action  being  simply  the  abstraction  of  water  from  the 
tissues,  with  slight  irritation  which  the  loss  of  ^^■ater  occasions.  Alcohol 
has  a  similar  action,  although  more  irritating  because  of  its  stronger 
affinity  for  water  accompanied  by  coagulation  of  albuminous  matter. 
The  irritation  in  each  case  continues  until  the  abstracted  fluids  have 
been  replaced  by  fluid  from  the  adjacent  tissues  or  from  the  blood. 
This  local  alteration  in  the  fluid  component  of  the  tissues  exemplifies 
a  principle  of  wide  application  throughout  the  body;  for  as  glycerin 
and  alcohol  abstract  small  amounts  of  water  locally,  so  physical  factors 
are  also  employed  in  the  withdrawal  of  large  quantities  of  fluid  through 
the  channels  of  elimination.  In  turn  the  fluid  of  the  blood  is  restored 
by  absorption  of  ingested  liquids  from  the  digestive  tract  or  by  taking 
up  a  certain  amount  from  the  tissues.  In  this  way  also  waste  products 
are  removed  from  the  cells  of  the  tissues  and  in  turn  they  receive  fresh 
nutritive  fluid  from  the  blood.  Much  of  this  action  we  must  attribute 
to  osmosis,  defined  to  be  the  property  by  which  liquids  and  crystalline 
substances  pass  through  animal  meuibranes.     This  process  takes  place 


ELECTRIC  ACTION  51 

between  the  cells  and  their  surrounding  fluid,  as  well  as  between  the 
capillaries  and  surrounding  media,  and  is  essential  to  the  course  of 
medicines  as  they  pass  through  the  body.  In  emergency,  as  after  a 
severe  hemorrhage,  the  same  principle  calls  for  the  hypodermic  use  of 
physiologic  salt  solution  in  quantity,  in  order  that  it  may  be  taken  up  by 
the  circulation.  In  the  treatment  of  nearly  every  disease,  this  same 
principle  finds  some  application. 

Any  extensive  interchange  of  fluids  is  brought  about  chiefly  through 
the  influence  of  what  is  termed  salt  action — i.  e.,  the  behavior  of  saline 
solutions  of  different  degrees  of  concentration  in  relation  to  the  salinity 
of  the  serum  of  the  blood,  by  which  a  flow  of  fluid  to  or  from  the  blood 
is  determined.  The  process  of  osmosis,  as  seen  in  the  passage  of  fluicfs 
of  different  composition  tlirough  a  separating  animal  membrane,  is  the 
most  important  factor  of  salt  action.  Having  the  blood  serum  of  a  cer- 
tain concentration  within  the  vessels  and  a  saline  solution  more  concen- 
trated without,  the  osmotic  flow  will  be  from  the  blood  to  the  stronger 
solution,  because  of  the  higher  osmotic  pressure  of  the  latter;  on  the 
contrary,  a  weaker  solution  outside  of  the  bloodvessels,  because  of  its 
lower  osmotic  pressure,  will  readily  pass  into  the  blood.  Thus  the 
administration  by  niouth  of  a  concentrated  solution  of  a  saline  cathartic 
will  promptly  cause  a  flow  of  serum  from  the  blood  current  into  the 
digestive  tract  (exosmosis),  while  pure  water  taken  into  the  digestive 
tract  would  pass  into  the  bloodvessels  (endosmosis) . 

A  single  drug,  potassium  bitartrate,  may  illustrate  both  exosmosis 
and  endosmosis:  For  if  it  be  given  in  form  of  the  salt  with  very  little 
water  it  will  attract  a  large  quantity  of  water  from  the  blood  and  so 
induce  a  cathartic  effect;  but  if  it  be  given  in  dilute  solution,  it  will 
pass  into  the  blood  and  be  carried  to  the  kidneys  to  be  eliminated,  where 
its  action  will  be  diuretic.  Any  solution  that  is  indifferent  in  osmotic 
action — i.  e.,  having  the  same  osmotic  pressure  as  the  blood  serum — is 
called  isotonic,  one  of  higher  osmotic  pressure  being  hypertonic  and  one 
of  lower  osmotic  pressure  being  hypotonic.  The  salinity  of  the  blood 
is  imitated  in  the  physiologic  saline  solution  containing  0.85  per  cent, 
of  sodium  chloride,  which  is  used  hypodermically,  intravenously,  or 
by  the  bowel,  as  a  restorative. 

Electric  Action. — Passing  from  purely  physical  influences,  we  recog- 
nize also  electric  relations  in  the  action  of  many  substances.  It  has 
been  ascertained  that  most  acids,  bases  and  salts,  when  in  dilute  solution, 
as  in  the  blood  and  tissues,  are  dissociated  into  ions  of  their  elements 
or  radicals,  that  these  are  charged  with  positive  and  negative  electricity, 


52  MODES  OF  ACTION  OF  MEDICINES 

and  that  the  solutions  are  capable  of  conducting  electrical  currents. 
The  ions  do  not  usually  act  as  the  pure  elements;  in  fact,  they  often 
exhibit  entirely  different  properties;  e.  g.,  in  the  dissociation  of  sodium 
chloride,  the  chlorine,  which  in  its  free  state  is  a  poisonous  gas, 
does  not  act  as  such,  but  as  the  electronegative  chlorine  ion,  while 
the  sodium,  which  in  its  free  state  is  an  irritant  base,  in  the  ionized 
form  is  non-irritating  and  provides  one  of  the  most  abundant  con- 
stituents of  the  body. 

The  practical  relation  of  ionization  to  the  use  of  drugs  is  important, 
as  may  be  illustrated  by  the  use  of  iodide  of  sodium  or  of  potassium. 
Here  the  element  iodine,  which  in  a  free  state  could  be  given  only  in 
small  quantity  because  of  its  irritating  quality,  may  be  given  in  a 
35-times  larger  dose  without  unpleasant  effects. 

The  combination  w  ith  the  base  renders  the  iodine  less  irritating  and 
the  subsequent  ionization  in  dilute  solution,  as  administered,  permits 
its  wide  diffusion  through  the  body  in  form  of  the  iodine  ion,  which  is 
comparatively  non-irritating. 

Little  can  be  said  of  definite  electric  reactions  as  a  part  of  drug  action 
within  the  tissues.  In  fact,  with  most  drugs  it  is  impossible  to  fully 
separate  the  physical,  the  electrical  and  the  chemical  factors,  blended 
as  they  are  in  the  life  action  of  the  cells. 

Chemical  Acticn. — The  chemical  features  of  drug  action  can  be  very 
clearly  demonstrated  for  certain  substances  of  local  use.  In  the  tooth 
structure  especially,  where  the  vital  factors  are  slight,  about  as  definite 
chemical  reactions  can  be  obtained  as  in  the  laboratory.  The  science 
of  bleaching  teeth  rests  upon  this  fact,  and  thorough  disinfection  by 
chemical  means  is  made  possible.  But  also  in  the  softer  structures  that 
possess  greater  vitality,  the  chemical  reactions  of  drugs  locally  applied 
are  often  very  evident,  e.  g.,  the  coagulant  action  of  phenol  and  the 
corrosive  action  of  strong  acids  and  alkalies.  These  reactions  and  their 
chemical  basis  are  more  fully  discussed  in  the  chapter  on  Escharotics. 
A  special  line  of  medication  where  the  action  is  purely  chemical  is  the 
application  of  chemical  antidotes  in  cases  of  poisoning. 

Secondary  Effects. — With  many  drugs  we  observe  both  primary  and 
secondary  efl'ects.  The  secondary  is  more  likely  to  be  the  desired  or 
therapeutic  effect,  or  to  lead  to  it.  To  illustrate:  The  application  of 
an  irritant  (tincture  of  iodine  or  mustard  paper)  to  the  gum  to  relieve 
toothache,  will  first  cause  irritation  (primary  effect),  then  alteration  of 
circulation  in  the  region  will  follow  (secondary  effect)  and,  pressure 
being  thereby  equalized,  we  have  relief  of  pain  (therapeutic  effect). 


UNTOWARD  EFFECTS  53 

However,  this  order  does  not  always  obtain  in  drug  action,  for  with 
some  drugs  the  first  action  is  the  desirable  one  and  later  effects  are 
undesirable. 

In  the  use  of  simple  irritants  and  astringents  we  observe  some  of  the 
reactionary  effects  of  drugs.  When  we  speak  of  irritation  we  mean  a 
disturbance  of  tissue,  or  a  reaction  to  a  disturbance,  inflammation  is 
a  reaction  of  higher  grade  having,  as  a  prominent  feature,  a  local  increase 
in  the  number  of  leukocytes  (leukocytosis),  which  becomes  general  in 
an  inflammation  of  any  severity.  This  condition  really  represents  a 
reactive  increase  in  the  protective  and  reparative  resources  of  the  blood 
and  tissues,  which  may  be  an  important  factor  in  securing  relief.  The 
action  of  an  irritant  drug  in  the  vicinity  of  an  inflammation  (counter- 
irritation)  is  believed  to  stimulate  absorption  by  the  lymphatics  as  well 
as  a  local  increase  of  leukocytes.  Thus  the  vital  factor  within  the  tissues 
aids  in  securing  the  therapeutic  efl^ect,  and  it  may  even  influence  the 
primary  action  of  the  drug.  This  factor  is  so  variable  that  for  most 
medicines  the  sum  of  the  effects  can  only  be  learned  by  experience,  and 
even  then  individual  peculiarity  (idiosjoicrasy)  may  determine  unex- 
pected results. 

Medicines  intended  for  general  systemic  effects  have  a  more  obscure 
action,  which  can  usually  be  judged  only  by  the  clinical  results  observed. 
In  general,  we  may  say  that  stimulants  and  sedatives  m^wervce  functions 
chiefly  and  their  action  is  temporary;  while  alteratives  and  restorative 
tonics  influence  the  structure  of  tissues  by  entering  into  the  composition 
of  the  cells,  their  effects  being  accordingly  more  permanent.  Stimulants 
may  irritate  tissue  primarily,  inducing  stimulation  reflexly,  or  they 
may  cause  more  rapid  or  more  powerful  discharges  of  energy  in  func- 
tional activity  of  the  organ  stimulated.  Sedatives  depress  functional 
activity,  usually  by  direct  influence  upon  nerve  tissue,  and  they  easily 
cause  poisoning  in  very  susceptible  persons.  A  more  detailed  discussion 
of  the  action  of  stimulants,  sedatives  and  alteratives  is  given  in  the 
separate  chapters  devoted  to  them. 

Untoward  Effects. — All  undesired  results  of  drug  action,  whether 
simply  unpleasant  or  positively  dangerous,  are  known  as  untoicard 
effects.  For  example,  the  pain  incident  to  a  blister,  the  nausea  caused 
by  some  drugs  given  for  other  purposes,  the  constipation  and  headache 
following  a  full  dose  of  opium  and  the  depression  caused  by  many 
pain-relieving  agents,  are  all  classed  under  this  term.  No  small  part 
of  the  prescriber's  art  lies  in  securing  the  desired,  and  avoiding  the 
untoward,  effects  of  his  remedies. 


54  MODES  OF  ACTION  OF  MEDICINES 

Protective  Reactions. — It  is  well  kno^ii  that  the  blood  possesses,  in 
some  degree,  protective  properties  against  certain  toxic  substances;  and 
one  of  the  important  developments  in  therapeutics  has  been  the  dis- 
covery that  the  protective  resources  may  be  increased  by  medication 
of  a  peculiar  kind,  or  added  to  artificially.  This  involves  the  question 
of  securing  immunity  or  the  production  ^^■ithin  the  body  of  antibodies 
that  are  antagonistic  to  the  germs  of  particular  diseases.  The  means 
•of  securing  this  end  differ  somewhat  with  different  diseases.  Thus, 
immunity  against  smallpox  is  positively  attained  by  inoculation  with 
the  living  virus  of  the  cowpox;  while  immimity  against  t\73hoid  fever 
is  secured  by  the  injection  of  a  hacterial  vaccine  or  baderin,  which  is  a 
preparation  of  killed  bacteria  of  the  kind  which  causes  the  disease. 

Vaccines  are  also  employed  in  prevention  and  treatment  of  other 
bacterial  diseases,  the  principle  being  that  of  stimulating  within  the 
body  the  formation  of  bodies  that  are  antagonistic  to  the  cause  of  the 
disease.  We  are  dealing  here  with  a  protective  reaction  on  the  part 
of  the  tissues  of  the  body,  the  process  being  a.  natural  one  under  the 
conditions  induced. 

Antitoxins.- — In  some  of  the  infectious  diseases  the  blood  reacts  to 
the  toxic  products  of  the  disease  and  develops  an  antitoxic  body,  which 
directly  neutralizes  the  poison  and  determines  recovery  in  favorable 
cases.  This  fact  is  made  use  of  in  the  treatment  of  diphtheria  and 
tetanus  particularly.  A  strong  antitoxin,  which  can  be  specific  for  the 
one  disease  only,  is  developed  in  the  blood  of  a  domestic  animal,  the 
serum  of  which  is  then  kept  in  a  preserved  state  for  use  when  needed. 
When  a  diagnosis  of  diphtheria  is  made,  this  antidiphtheric  serum  is  in- 
jected hypodermically  or  intravenously  as  early  as  possible,  with  the  result 
commonly  that  the  poison  of  the  disease  is  perfectly  neutralized.  Anti- 
toxins, being  natural  products  of  the  blood,  are  harmless  and  may  be 
used  in  strong  dosage. 

Phagocytosis. — The  protective  resources  of  the  body  include  also  the 
white  blood  cells,  or  leukocytes,  which  increase  in  number  greatly  in 
most  fe^'ers  and  infections.  Aside  from  their  function  of  repairing  tis- 
sues, they  have  the  power  to  destroy  bacteria  in  the  blood  (phagocytosis) 
and  thus  they  form  a  very  important  part  of  the  body  defenses.  In 
this  relation  they  are  called  phagocytes. 


PART  II. 
LOCAL  REMEDIES. 


CHAPTER  V. 

DEPLETIVES. 

Depletive  measures  are  those  employed  to  abstract  blood  or  serum 
from  an  inflamed  or  hjqDeremic  area,  usually  with  the  purpose  of  reliev- 
ing pain  or  pressure.     The  indications  for  their  use  are: 

1.  Inflammation  that  is  painful  or  that  threatens  extension  or  destruc- 
tion of  tissue. 

2.  Passive  congestion  of  a  part  that  interferes  with  its  function  or 
with  resolution  of  disease. 

.3.  Simple  hj'peremia,  when  its  continuance  is  likely  to  produce  serious 
disturbance  of  tissue  or  function. 

4.  In  local  poisoning  of  tissues,  as  from  the  bite  of  an  animal,  or 
from  local  absorption  of  arsenic.  i^ ^^4    ^ 

A  depletive  measm-e  need  not  always  remove  blood  or  serum  from  the 
body.     It  may  draw  it  from  the  point  of  disease  into  another  part. 


Fig.  1. — Dry  cups  applied  to  the  chest,  as  in  a  case  of  puhnonar}'  edema,  the  early 
stages  of  pneumonia,  or  diffuse  bronchitis.     (Hare.) 

Dry  Cupping  consists  in  the  application,  to  the  surface  of  the  skin,  of 
glass  cups  from  which  the  air  has  been  exhausted.     An  alcohol  flame 


56  DEPLETIVES 

passed  quickly  into  the  cup  immediately  before  applying,  is  the  means 
commonly  employed  to  exhaust  the  air.  The  vaciuun  permits  the  skin 
and  underlying  tissue  to  bulge  into  the  glass  and  to  become  congested 
with  blood.  In  this  way,  with  each  cup  nearly  or  quite  a  tablespoonful 
of  fluid  may  be  drawn  from  deeper  tissues  to  the  skin  and  just  beneath 
it.  With  the  emplo\-ment  of  a  number  of  cups  a  very  decided  influence 
upon  a  deeper-lying  inflammation  is  noticed,  but  no  fluid  is  removed  from 
the  body.  This  method  is  of  great  value  in  conditions  of  pulmonary 
congestion  or  pneimionia,  and  a  number  of  cups  may  be  applied,  and 
repeatedly,  to  the  surface  of  the  chest.  The  cups  cannot  be  applied 
upon  an  irregular  surface. 

Wet  cupping  is  accomplished  by  applying  the  same  principle  after 
first  scarifying  a  limited  surface  with  an  ordinary  lancet,  or  with  the 
especially  adapted  spring  lancet.  The  cup  can  then  be  a])plied  as  in 
dry  cupping,  or  a  special  cup  with  an  exhaust  s\Tinge  attached  may 
be  used.  The  latter  permits  of  a  more  constant  vacuum  being  main- 
tained. The  vacuum  allows  a  free  flow  of  blood  into  the  cup.  By  this 
method  a  considerable  quantity  of  blood  may  be  abstracted  from  any 
part  of  the  body. 

Scarification  with  a  lancet  is  the  method  of  depletion  most  commonly 
used  in  dental  practice.  The  indications  are  hyperemia,  inflammation, 
passive  congestion,  and  local  poisoning,  as  by  arsenic.  After  scarifica- 
tion, bleeding  may  be  encouraged  by  holding  warm  water  in  the  mouth, 
while  cold  water  will  tend  to  lessen  the  flow. 

The  precautions  to  be  observed  in  scarification  are:  Strict  asepsis, 
guarding  against  too  extensive  a  wound  by  a  sudden  movement  on 
the  part  of  the  patient,  and  avoiding  the  proximity  of  vessels,  nerves, 
or  of  Stensen's  duct  opposite  the  first  superior  molar. 

Lancing  of  the  gums  over  advancing  teeth  is  called  for  when  unusual 
hyperemia  or  swelling  is  present,  or  where  general  irritability,  fever, 
or  convulsions  point  to  a  local  irritation  which  is  found  in  an  abnormal 
eruption  of  the  teeth.  It  must  be  borne  in  mind,  however,  that  sources 
of  irritation  may  exist  in  other  parts  of  the  digestive  tract,  and  that  in 
a  dentition  which  is  progressing  normally  there  is  seldom  any  need  of 
scarifying  the  gums.  When  employed,  the  incision  should  be  directly 
over  the  advancing  margins  of  the  teeth. 

Leeching, — The  application  of  a  leech  {Hirudo  medicinalis)  is  a  con- 
venient and  efficient  means  of  abstracting  blood  from  a  local  point 


VENESECTION  OR  PHLEBOTOMY  57 

for  the  relief  of  acute  inflammation  or  congestion.  For  use  in  the 
mouth  it  is  not  generahy  applicable,  on  account  of  the  aversion,  on 
the  part  of  some  people,  to  having  a  leech  in  the  mouth.  Nevertheless, 
it  is  to  be  considered  among  the  best  means,  and  if  employed  with  a 
leech  tube  so  that  it  does  not  touch  the  tissue  except  by  its  sucker 
extremity,  the  objection  is  minimized.  The  leech  tube  is  of  glass,  of 
a  proper  size  to  admit  the  leech  and  allow  its  distention  by  blood.  It 
is  dravMi  to  a  narrow  opening  at  one  end.  This  smaller  opening  should 
be  large  enough  to  permit  the  passage  of  the  smaller  end  of  the  leech 
by  which  it  makes  suction.  Swedish  leeches  are  mostly  employed  on 
account  of  their  large  size,  their  capacity  for  abstracting  blood  vary- 
ing from  one-half  to  two  fluidrachms  (2  to  8  mils).  If  the  leech  does 
not  bite  readily  it  may  be  advisable  to  make  a  puncture  with  a  fine 
point  at  the  selected  place,  in  order  to  obtain  a  small  drop  of  blood 
upon  the  surface.     This  will  usually  induce  the  leech  to  bite. 


(T 


D 


Fig.  2. — Leech  glass. 

The  suction  may  be  interrupted  at  any  time  by  sprinkling  a  little 
salt  upon  the  leech,  when  it  will  drop  off.  The  leech  bite  is  V-shaped 
and  clean  cut.  Bleeding  may  continue  for  some  time,  and  may  even 
require  the  use  of  strong  styptics  or  pressure  in  order  to  check  it.  When 
applied  to  the  skin  a  small  triangular  scar  invariably  remains  from 
the  leech's  bite,  therefore,  when  used  upon  the  face  or  neck,  the  point 
of  application  of  a  leech  should  be  where  the  scar  will  not  be  noticeable, 
as  under  the  chin,  behind  the  ear,  at  the  angle  of  the  eye  or  nose,  within 
the  hairy  region,  or  at  the  site  of  a  natural  wrinkle. 

As  related  to  all  means  of  local  bleeding  it  must  be  borne  in  mind 
that  the  hemorrhagic  diathesis  {hemophilia)  is  an  absolute  contra- 
indication to  their  emplo}Tnent. 

Venesection  or  Phlebotomy .^ — General  bloodletting  is  accomplished  by 
opening  a  vein  (usually  the  cephalic,  just  at,  or  above  the  bend  of  the 
elbow).  This  therapeutic  measure  was  much  abused  in  earlier  years, 
and  the  natural  reaction  resulted  in  its  almost  complete  abandonment. 
At  the  present  time,  however,  it  is  often  employed  as  an  emergency 
procedure,  in  cases  of  severe  toxemia  or  physical  embarrassment  of  the 
circulation.  A  pint  or  more  of  blood  may  be  drawn.  The  flow  is 
easily  stopped  by  the  simple  pressure  of  the  dressing  applied. 


58  DEPLETIVES 

In  order  to  find  the  A^ein  readily  and  to  secure  its  distention  and 
consequent  free  flow  of  blood,  a  bandage  is  first  placed  around  the 
arm  just  below  the  shoulder  and  drawn  tightly  enough  to  obstruct 
the  venous  return,  but  not  to  interfere  with  the  arterial  flow.  This 
causes  a  fulness  of  the  vessels  of  the  arm  and  great  distention  of  the 
veins.  The  median  cephalic  is  then  exposed  with  aseptic  care  and  the 
opening  made  with  the  ordinary  sterile  lancet. 

General  depletion  is  also  secured  by  means  of  sweating  or  by  free 
catharsis.  In  either  case  it  is  possible  to  withdraw  from  one  to  three 
pints  of  serum  from  the  circulation  within  a  short  time,  which  result 
may  be  a  considerable  factor  in  lessening  a  local  hyperemia  or  inflam- 
mation. Sweating  is  most  readil}^  induced  by  the  hot-air  bath,  taken 
either  sitting  (cabinet  bath)  or  lying  down  (hot-air  bed  bath).  The 
hot  mustard  foot  bath  also  is  efficient,  adding  to  the  sweating  the 
derivative  rubefacient  effect  upon  the  lower  limbs. 

A  depleting  catharsis  is  secured  by  the  action  of  a  quickly  acting 
hydragogue,  such  as  jalap,  croton  oil,  and  the  saline  cathartics.  The 
salines  are  most  commonly  used.  When  given  in  concentrated  solution 
(hypertonic,  see  p.  51)  upon  an  empty  stomach,  they  act  promptly  by 
causing  a  copious  flow  of  serum  from  the  bloodvessels  into  the  diges- 
tive tract,  followed  by  evacuation  without  much  irritation.  The  state 
of  blood-pressure  modifies  their  activity  somewhat,  a  fulness  of  the 
circulation  favoring  an  outward  flow  of  serum.  A  low  blood-pressure 
would  require  salines  to  be  given  in  larger  quantity  for  the  same  desired 
result. 

The  vegetable  hydragogues  are,  as  a  rule,  more  violent  and  drastic 
in  action,  because  they  irritate  the  bowel  and  greatly  stimulate  peri- 
staltic action.  Jalap  is  milder  than  others,  and  very  efficient  when 
simple  depletion  is  desired,  and  it  may  be  used  daily  for  some  time;  but 
when  a  revulsive  action  is  wanted  the  more  irritating  croton  oil  is  used. 

General  depletion,  as  above,  is  indicated  where  there  is  accumula- 
tion of  serum  in  a  serous  cavity,  as  the  pleural  or  peritoneal,  or  where 
cardiac  or  hepatic  disease  is  attended  with  marked  venous  congestion. 


CHAPTER  VI. 

COUNTERIRRITANTS. 

CouNTERiRRiTATiON  means  the  production  of  an  irritation  in  a 
normal  part  of  the  system  in  order  to  influence  a  diseased  part  favor- 
ably. The  irritant  is  usually  applied  to  the  skin,  but  it  may  be  applied 
to  the  mucous  membrane  of  the  mouth  or  to  other  accessible  mucous 
surfaces.  The  action  varies  in  degree  from  a  simple  reddening  of  the 
skin,  by  increase  of  the  circulation  locally,  to  a  destruction  of  the  super- 
ficial layer  of  tissue.  According  to  the  degree  of  irritation  following 
their  application,  the  agents  are  divided  into: 

1.  Rubefacients,  agents  that  produce  redness  of  the  surface. 

2.  Vesicants  or  epispastics,  agents  that  irritate  sufficiently  to  cause 
an  exudate  of  serum  beneath  the  epidermis  (a  blister) . 

3.  Escharotics,  caustics  or  coirosives,  agents  that  destroy  tissue. 
The  same  agent  may  be  a  rubefacient,  a  vesicant  or  a  caustic,  as 

determined  by  the  strength  and  duration  of  its  application.  This  may 
be  illustrated  by  the  application  of  heat  to  the  skin.  Moderate  heat 
will  cause  a  dilatation  of  the  cutaneous  bloodvessels,  with  a  decided 
hyperemia  (rubefacient  effect);  a  higher  degree  of  heat  will  determine 
the  escape  of  serum  from  the  engorged  vessels  to  the  extent  of  lifting 
up  the  non- vascular  epidermis  (vesicant  effect);  and  a  degree  of  heat 
that  will  burn  will  cause  destruction  of  the  skin  (escharotic  effect). 

Agents  will  be  selected,  therefore,  for  the  degree  of  effect  desired. 
While  some  of  them  will  produce  any  of  the  above  effects,  others  are 
more  limited  and  fall  naturally  into  only  one  class.  Thus,  arsenic 
acts  slowly,  and  it  cannot  be  said  to  produce  any  typical  effect  other 
than  escharotic;  capsicimi  usually  produces  only  a  rubefacient  effect. 
It  must  be  noted,  however,  that  the  thickness  and  texture  of  the  skin 
will  cause  a  difference  in  effect,  from  the  same  application,  in  different 
individuals,  and  in  the  same  person  upon  different  parts  of  the  body. 
A  thin,  tender  skin  will  blister  much  more  easily  than  a  thick,  tough  one. 

It  must  also  be  noted  that  the  same  irritant  will  have  a  much  severer 
effect  upon  the  mucous  membrane  than  upon  the  skin,  on  account  of 
the  softer  and  looser  texture  of  the  former;  e.  g.,  tinctme  of  iodine  by  a 
single  application  will  only  irritate  the  skin  slightly,  but  it  will  quickly 
corrode  and  destroy  the  superficial  layer  of  a  mucous  membrane. 


60  COUNTERIRRITANTS 

The  severer  degree  of  counterirritation  (i.  e.,  blistering)  should  be 
avoided  both  in  childhood  and  in  old  age,  because  of  the  greater  sus- 
ceptibility to  irritation  and  the  lower  vital  resistance  at  the  extremes 
of  life. 

Several  rules  may  be  wisely  o})served  as  to  the  site  of  application  of 
a  counterirritant  in  typical  conditions: 

1.  If  an  inflammation  is  quite  superficial,  the  counterirritant  should 
be  applied  at  a  short  distance.  If  applied  immediately  at  the  i)oint  of 
inflammation,  the  latter  may  be  aggravated. 

2.  If  deep  inflammation  is  to  be  treated,  the  irritant  is  applied  directly 
over,  so  as  to  induce  a  flow  of  blood  to  the  surface  and  away  from 
the  deeper  point  of  disease. 

3.  In  case  of  neuralgia  or  neuritis,  the  irritant  may  be  applied  with 
best  effect  directly  over  the  origin  of  the  affected  nerve,  or  at  the  point 
of  its  emergence. 

4.  In  treating  affections  about  the  face  and  head,  the  irritant  may  be 
applied  back  of  the  ear,  beneath  the  chin  or  upon  the  back  of  the  neck. 

Modes  of  Actio7i  of  Counterirritants. — The  remedial  effect  of  a  coun- 
terirritant is  probably  brought  about  by  a  threefold  action.  They 
influence:  (1)  The  circulation;  by  causing  a  hyperemia  through  vaso- 
dilation at  the  point  of  irritation  the  tendency  of  the  blood  supply  will 
be  in  that  direction.  (2)  They  turn  the  attention  of  the  system  toward 
the  new  point  of  irritation  and  a\\'ay  from  the  disease,  partly  a  mental 
effect.  (3)  They  influence  the  innervation  of  the  diseased  part  by  the 
reflex  influence  of  the  irritation.  In  the  sum  of  their  effects  they 
stimulate  the  movement  of  fluids  within  the  tissues;  hence,  they  are 
regarded  as  l\inphatic  stimulants  and  are  often  employed  to  stimulate 
the  absorption  of  serous  or  inflammatory  exudate. 

The  terms  derivative  and  revuhive  are  often  applied  to  the  action  of 
counterirritants,  the  latter  of  the  t"v\o  referring  especially  to  a  very 
decided  action,  as  in  the  prompt  and  violent  effect  of  croton  oil  as  a 
cathartic,  \\hen  given  to  relieve  a  cerebral  condition. 

Heat.^ — This  agent  has  an  important  place  as  a  counterirritant, 
because  of  the  readiness  and  variety  of  forms  in  which  it  can  be  applied. 
The  hot-water  bag,  dry  and  moist  poultices,  hot  foot  and  sitz  baths, 
the  hot  iron,  the  thermocautery  and  the  galvanocautery  indicate  the 
range  of  methods  and  effects  that  attach  to  the  use  of  heat. 

The  irritant  drugs,  other  than  escharotics,  are  here  discussed  in  the 
order  of  their  severity,  beginning  with  the  mildest.  Escharotics  are 
considered  in  a  separate  chapter. 


SI  NAP  IS  NIGRA  61 

Capsicum. — Cayenne   Pepper. — The   fruit   of   Capsicum  frutescens. 

Preparations  and  doses: 

Oleoresina  capsici,  gr.  |  (0.03  gm.). 
Emplastrum  capsici — external  use. 
Tinctura  capsici,  lU  8  (0.5  mil.). 

The  most  irritating  preparation  of  capsicum  is  the  oleoresin,  which 
is  seldom  employed  undiluted.  The  tincture  may  be  applied  to  the 
mucous  membrane  in  sluggish  or  atonic  conditions.  It  acts  by  irri- 
tating, and  thereby  inducing  a  more  active  local  circulation.  Diluted 
with  water,  it  may  be  used  as  a  wash  or  gargle.  The  official  plaster 
is  prepared  by  spreading  the  oleoresin  upon  resin  plaster.  It  is  used 
as  a  counterirritant  to  the  skin  or,  in  a  limited  area,  to  the  gums,  as  in 
the  beginning  of  pericementitis.  The  powdered  driig  is  likewise  recom- 
mended as  a  dental  counterirritant.  To  limit  and  concentrate  its 
action  it  must  be  enclosed  in  a  small  sack,  and  in  this  way  it  may  be 
combined  with  other  drugs  if  desired. 

The  drug  and  its  preparations  are  capable  of  causing  irritant  poison- 
ing if  taken  internally  in  large  doses. 

Sinapis  Alba. — White  Mustard. — The  seed  of  Sinapis  alha. 

Sinapis  Nigra. — Black  Mustard. — The  seed  of  Brassica  nigra. 
Preparations  and  doses  of  black  mustard: 

Emplastrum  sinapis  {mustard  paper) — external  use. 
Oleum  sinapis  volatile,  TH,  |  (0.008  mil.). 
Powdered  mustard  (as  emetic),  32|  (10  gm.). 

These  two  drugs  are  similar  as  to  constituents  and  uses,  although 
the  black  is  the  more  powerful  and  claims  our  chief  attention.  Mus- 
tard in  a  dry  state  is  not  irritating,  but  the  black  mustard  seed  contains 
a  glucoside,  sinigrin  and  an  enzyme,  myrosin,  which,  in  the  presence 
of  water,  react  to  form  the  very  irritating  volatile  oil  {oleum  sinapis 
volatile).  Myrosin  in  aqueous  solution  coagulates  at  140°  F.  (60°  C); 
therefore,  a  temperature  of  that  degree  or  higher  will  prevent  the 
development  of  the  volatile  oil.  Alcohol  and  acids  also  interfere  with 
its  production.  Water  at  ordinary  temperature  is  the  agent  to  use  to 
develop  the  valuable  constituent  of  the  drug. 

Taken  internally  mustard  is  an  excellent  emetic,  the  effect  being 
due  tc  its  irritation  of  the  stomach.  In  case  of  poisoning  by  opium  or 
arsenic,  or,  in  fact,  by  any  except  the  most  irritant  poisons,  if  the  case 
is  seen  early  while  the  poison  is  still  in  the  stomach,  a  tablespoonful 
of  mustard  stirred  up  in  a  glass  of  water  and  taken  at  oime  is  a  most 
efficient  emetic.     Mixed  with  enough  water  to  form  a  paste,  mustard 


62  COUNTERIRRITANTS 

is  applied  between  two  layers  of  muslin  to  produce  quick  and  moderate 
counterirritation,  which,  if  prolonged,  may  proceed  to  vesication.  For 
a  continued  rubefacient  effect,  the  mustard  may  be  diluted  by  mixing 
with  from  one-fourth  to  half  as  much  flour  before  adding  water.  A 
mustard  plaster  or  poultice  thus  prepared  is  called  a  sinapism. 

The  irritant  power  of  this  drug  makes  it  a  valuable  addition  to  the 
hot  foot  bath.  Here  the  mustard  is  to  be  stirred  up  in  cold  water,  and 
the  mixture  allowed  to  stand  for  several  minutes,  then  added  to  the 
hot  water  for  the  bath.  In  the  treatment  of  pericementitis  or  other 
active  inflammation  in  the  upper  part  of  the  body,  the  hot  mustard 
foot  bath,  carried  to  the  point  of  thorough  relaxation  and  sweating, 
is  a  valuable  general  measure.  In  similar  conditions  of  inflammation 
about  the  face  or  mouth  a  mustard  plaster  may  be  applied  to  the  back 
of  the  neck.  A  preparation  of  some  value  to  the  dentist  is  mustard 
paper  (Emplastrum' sinapis) ,  in  which  powdered  black  mustard,  freed 
from  fixed  oil,  is  mixed  with  a  solution  of  india-rubber,  and  spread  upon 
paper  or  upon  cloth.  Protected  from  moisture,  mustard  paper  will  keep 
indefinitely,  and  it  may  be  found  at  any  time  ready  prepared  in  the 
stores.  For  local  blistering  of  the  mucous  membrane  in  the  treatment 
of  pericementitis,  it  is  cut  into  small  squares  or  other  suitable  shapes 
and  applied  directly  to  the  gum  over  an  offending  tooth.  The  moisture 
of  the  mouth  will  cause  the  volatile  oil  to  develop  ciuickly.  It  is  very 
convenient  also  for  more  extensive  irritation  upon  the  surface  of  the 
body,  but  when  used  upon  the  skin  the  plaster  must  be  moistened  with 
water  before  application,  so  as  to  secure  the  reaction  which  develops 
the  oil.  Volatile  oil  of  mustard  may  be  used  as  an  irritant,  by  being 
applied  pure  for  limited  effect,  or  diluted  with  alcohol  for  extensive 
effect;  but  it  has  a  very  rank  odor  which  is  objectionable. 

Oleum  Terebinthinae. — Oil  of  Tirpextine. — The  volatile  oil  distilled 
from  turpentine.     Dose  of  the  rectified  oil,  TTlo  (0.30  mil.). 

Crude  turpentine  is  the  solid  oleoresin,  or  pitch,  which  exudes  from 
the  pine  tree  when  the  bark  is  cut.  By  distillation  it  is  separated  into 
the  volatile  oil  of  turpentine  and  a  solid  residue  called  resin  or  rosin. 
The  oil  is  colorless,  with  a  characteristic  odor  and  taste,  which  become 
stronger  and  less  pleasant  with  age  and  exposure  to  air.  It  is  soluble 
in  5  parts  of  alcohol  and  in  1  part  of  glacial  acetic  acid.  For  internal 
use  the  rectified  oil  is  preferred.  It  is  neutral,  while  the  commercial 
oil  may  be  slightly  acid. 

Oil  of  turpentine  is  used  mostly  as  a  rubefacient  over  a  large  surface, 
as  upon  the  abdomen  or  front  or  back  of  the  chest.     It  may  blister 


lODUM  63 

if  used  full  strength.  The  ofRcial  liniment  (35  per  cent.)  may  be  used, 
or  a  turpentine  stupe  employed.  The  latter  is  prepared  by  wringing 
a  piece  of  flannel,  about  twelve  inches  square,  out  of  very  hot  water, 
then  distributing  from  ten  to  thirty  drops  of  oil  of  turpentine  upon  it. 
It  is  then  quickly  spread  out,  while  still  hot,  upon  the  surface  to  be 
treated,  and  covered  with  several  layers  of  fabric.  This  may  be  renewed 
frequently  so  as  to  keep  up  a  constant  rubefacient  action. 

This  drug  is  a  useful  general  antiseptic,  and  it  may  be  used  to  cleanse 
instruments  or  disinfect  the  skin,  but  the  odor  is  objectionable  to  some. 
It  has  been  employed  as  a  local  antiseptic,  but  is  not  used  in  dentistry 
to  any  extent;  the  old  oxidized  oil  may  be  used  as  deodorant  in  moist 
gangrene  of  the  pulp,  to  destroy  the  extremely  unpleasant  odor.  It 
does  not  coagulate  albumin,  so  that  except  for  its  unpleasant  odor  it 
might  be  an  excellent  penetrating  antiseptic. 

In  poisoning  by  phosphorus  this  drug  has  long  been  regarded  as  a 
valuable  chemical  antidote,  if  administered  while  the  poison  is  still 
within  the  digestive  tract ;  but  this  is  true  only  of  an  old,  highly  oxidized 
oil,  tne  old,  French  oil  being  most  valuable.  Fresh  oil  of  turpentine 
will  dissolve  phosphorus  and  must,  therefore,  be  avoided. 

Incompatibility. — It  reacts  violently  with  bromine  or  powdered  iodine, 
and  in  contact  with  a  mixture  of  nitric  and  sulphuric  acids  it  will  ignite. 

lodum. — Iodine  [I]. — ^A  solid  non-metallic  element,  found  in  sea-weeds 
and  in  natural  mineral  compounds,  its  chief  commercial  source  being 
sodium  iodate,  obtained  in  Chili.  The  drug  is  seldom  used  internally 
except  in  form  of  iodides.     Preparations  and  doses: 

Liquor  lodi  compositus,  Lugol's  solution,  (5  per  cent.),  TU  3  (0.2  mil.). 
Tinctura  lodi  (7  per  cent.),  m  H  (0.1  miJ.). 
Unguentum  lodi  (4  per  cent.),  external  use. 
See  also  Iodides. 

All  of  these  preparations  contain  potassium  iodide. 

Pure  iodine  occurs  in  bluish-black,  rhombic  plates,  having  a  penetrat- 
ing odor  and  sharp  taste.  It  is  slowly  volatile,  soluble  in  12.5  parts  of 
alcohol,  in  80  parts  of  glycerin  and  freely  in  ether;  also  soluble  in  an 
aqueous  solution  of  potassium  iodide,  although  nearly  insoluble  in 
water.*  These  solutions  are  brown  in  color,  while  chloroform  and 
carbon  disulphide  each  dissolve  it  with  a  violet  color. 

*  Iodine  is  soluble  in  about  3000  parts  of  water.  According  to  the  U.  S.  Dispen- 
satory, eighteenth  edition,  its  solubility  in  water  may  be  increased,  not  only  by 
potassium  iodide,  but  by  sodium  chloride,  ammonium  nitrate  and,  to  some  degree, 
by  tannic  acid.  The  official  tincture  now  contains  5  per  cent,  of  potassium  iodide, 
which  renders  the  solution  miscible  with  water  in  any  proportion  without  precipitation. 


64  COUNTERIRRITANTS 

Iodine  in  the  form  of  the  tincture  is  an  irritant  of  great  vahie,  as 
appHed  either  to  the  skin  or  mucous  membrane.  Upon  the  latter  it 
should  be  used  only  to  a  limited  extent,  as  it  will  quickly  corrode  the 
superficial  layer.  As  a  counterirritant  to  the  gum  in  pericementitis, 
or  irritated  or  inflamed  pulp,  it  is  invaluable.  Iodine  is  a  penetrating 
agent,  although  the  alcohol  in  the  tincture  will  coagulate  albumin 
slightly.  In  common  with  other  irritants  it  has  the  power  to  stimu- 
late absorption  by  the  Ijinphatics,  ^^"hich  is  regarded  as  a  valuable  part 
of  its  local  action.  The  great  advantages  possessed  by  the  tincture  are 
promptness  and  limitation  of  its  action.  The  alcohol  ciagulaies  the 
tissue,  thus  limiting  action,  and  the  excess  evaporates  quickly,  leaving 
a  dry  surface.  Where  coagulation  is  a  disadvantage,  or  where  the 
action  of  alcohol  is  not  desired,  the  compound  solution  may  be  used, 
but  it  is  slightly  weaker  than  the  ordinary  tincture.  Churchill's  tincture 
(X.  F.)*  is  much  stronger  than  the  official  tincture,  and  is  too  irritating 
for  application  to  the  mucous  membrane.  The  favorite  combination  of 
equal  parts  of  tincture  of  iodine  and  tincture  of  aconite  may  be  used 
more  freely,  as  in  it  the  iodine  becomes  diluted  and  its  irritant  action 
counteracted  somewhat  by  the  aconite,  which  is  a  local  sedative,  t  The 
brown  stain  produced  by  iodine  makes  it  objectionable  to  use  upon  a 
visible  surface,  and  it  should  never  be  used  within  a  tooth,  for  fear 
of  permanent  staining  of  the  dentine.  Stains  upon  the  hands  or  upon 
fabrics  are  easily  removed  by  water  of  ammonia. 

As  an  antiseptic  and  disinfectant,  iodine  is  very  efficient.  The 
tincture  diluted  with  an  equal  part  of  alcohol  is  used  to  sterilize  regions 
to  be  operated  upon  in  the  mouth  as  well  as  elsewhere.  The  use  of 
strong  solutions  in  the  mouth,  except  as  a  counterirritant,  is  to  be 

*  I65  %.    This  differs  from  Churchill's  iodine  caustic  {Liquor  iodi  causticus,  N.  F.), 
which  is  stronger  still,  containing  about  25  per  cent,  iodine, 
t  A  very  useful  formula  is : 
I^ — Tinctura^  iodi, 

Tinctura;  aconiti aa    f5ij  (60  mil.) 

Chloroformi 3j    (  4  mil.) — M. 

Note. — Boulton's  solution  (Liquor  iodi  cirbolatus,  N.  F.)  is  a  time-honored  and 
generally  useful  combination  of  iodine  and  phenol,  much  weaker  than  the  official 
preparations  of  iodine.     Its  formula  is: 

Gm.  or  mil. 

I^ — Tincturse  iodi   compositae 15 1 

Phenolis  (liquefied  by  heat) 5l5 

Glycerini 165 

Aqua? q.  s.  ad  1000     — M. 

Expose  to  sunlight  until  it  has  become  colorless. 


lODUM 


65 


condemned,  on  account  of  its  destructive  action  on  the  tissues.  Upon 
the  skin  the  tincture  may  be  used  in  full  strength.  It  may  be  applied 
in  strong  solution  to  ulcers,  but  is  quite  painful.  For  cleansing  abscess 
cavities  the  tincture  or  the  compound  solution  may  be  used  somewhat 
diluted,  either  applied  upon  cotton  or  injected  carefully.  It  may  also 
be  carried  into  the  tissues  by  cataphoresis,  by  which  method  it  is  very 
useful  in  treating  pericementitis,  pericemental  abscess,  and  especially 
the  affections  of  the  pericementum  that  follow  influenza  (Hofheinz). 

In  selecting  an  iodine  solution  for  use  we  should  have  in  mind  the 
distinctive  qualities  of  each,  as  given  below,  for  the  three  preparations 
most  commonly  employed: 


1.  Tincture  of  iodine,  7  per 
cent. 


2.  Compound    solution    of 

iodine,     5    per    cent. 
(Lugol's  solution).* 

3.  Ecjual  parts  of  tincture 

of  iodine  and  tincture 
of  aconite. 


Comparative  action  upon 
mucous  membrane. 


Mixed  with  albumin. 


Most  severe  irritant;  cor-  |  Immediate  coagulation  due 
rodes       mucous      mem- ;     chiefly     to     the     alcohol 
brane    superficially    and      present, 
promptly. 

Moderate     irritant;     does    Coagulation     sHght,      and 
not  corrode.  slowly  produced. 


Moderate  irritant ;  cor- 
rodes more  slowly  than 
tincture  of  iodine  alone, 
and  sometimes  only  after 
several  appUcations. 


Immediate  coagulation  due 
chiefly  to  the  alcohol 
present. 


The  tincture  may  be  combined  with  carbolic  acid,  which,  with  full 
strength  of  each,  increases  the  corrosive  and  coagulating  action.  Equal 
parts,  or  any  desired  variation  from  this,  may  be  used.  Such  mixture 
diluted  with  alcohol  or  glycerin  is  a  proper  application  to  abscess 
cavities,  ulcers,  unhealthy  gums  in  stomatitis,  etc.,  as  it  will  combine 
disinfectant,  irritant  and  indirectly  stimulant  properties.  ^Yhen  prop- 
erly diluted  the  carbolic  acid  may  contribute  a  local  sedative  effect. 

Water  can  be  used  to  dilute  the  official  tinctm*e,  as  the  formula  now 
includes  5  per  cent,  of  potassium  iodide,  w'hich  will  hold  the  iodine  in 

*  The  formula  of  Lugol's  solution  (Liquor  iodi  compositus)  is : 


I^- 


-lodi    .      .      .      , 
Potassii  iodidi 
Aquae  destillatae 


Gm.  or  mil. 

.  .  .  51 
.  .  .  10 1 
q.  s.  ad     100  j  — M. 


The  potassium  iodide  is  needed  to  hold  the  iodine  in  solution. 
5 


66  COUNTERIRRITANTS 

solution.  Such  dilution  is  a  very  great  advantage  in  some  of  the  uses 
of  the  tincture.  Iodine  has  a  reputation  as  a  stimulant  to  absorption 
by  the  hinphatics,  in  common  with  almost  all  counterirritants  and 
alteratives,  with  the  advantage  that  it  belongs  to  both  of  these  classes. 
To  influence  the  absorption  of  indolent  swellings  or  to  reduce  enlarged 
l}Tnph  nodes,  either  the  tinctiue  or  Lugol's  solution  may  be  applied 
(the  tincture  possessing  the  very  great  advantage  of  drying  quickly), 
although  after  a  number  of  applications  the  skin  becomes  blister^  or 
broken,  when  their  use  becomes  very  painful.  A  better  preparation 
for  continued  use  is  the  ointment  (containing  4  per  cent,  iodine  and  4 
per  cent,  potassium  iodide),  which  may  be  applied  daily,  with  friction 
to  aid  absorption. 

Decolorized  tincture  of  iodine,*  so  called,  is  less  irritating  and  less 
efficient  than  the  other  solutions,  but  it  may  be  applied  where  the  color 
of  the  latter  would  forbid  their  use.  It  does  not  dry  readily  upon  the 
skin,  which  is  an  objection  to  its  employment. 

In  poisoning  by  iodine  the  proper  chemical  antidote  is  starch, 
preferably  in  the  form  of  starch  paste.     This  should  be  given  freel}'. 

IncomimtihiUty . — Free  iodine  is  incompatible  with  starch,  forming 
the  blue  iodized  starch;  with  oil  of  turijentine,  mixture  with  which  may 
be  followed  by  violent  reaction. 

Internally  the  drug  is  used  mostly  in  the  form  of  iodides,  for  the 
reason  that  these  salts  are  much  less  irritating  and  therefore  permit 
a  much  larger  quantity  of  iodine  to  be  taken.  As  an  alterative  it  will 
be  further  discussed  in  the  chapter  devoted  to  that  class  of  remedies. 

Oleum  Tiglii. — Ceoton  Oil.^A  fixed  oil  expressed  from  the  seed  of 
Croton  tiglium,  a  small  tree  indigenous  in  India.  A  brownish-yellow 
oil,  soluble  in  60  parts  of  alcohol,  becoming  darker  and  more  soluble 
with  age.     It  has  an  unpleasant,  fatty  odor  and  an  acrid  taste. 

Average  dose,  TTl  1  (0.05  mil.). 

Croton  oil  is  an  irritant,  whether  applied  to  the  skin  or  taken  inter- 
nally. When  rubbed  into  the  skin  it  acts  slowly,  producing  in  from 
twelve  to  twenty-four  hours  a  crop  of  small  vesicles,  which  are  distinct 
and  separated  from  each  other.  If  undisturbed,  these  dry  without 
breaking.  The  counterirritant  effect  is  pronounced,  with  much  less 
discomfort  than  from  cantharides.    The  drug  may  be  applied  back 

*  Tinctura  iodi  decoJorata  (N.  F.)  is  prepared  with  the  aid  of  sodium  thiosulphate 
and  stronger  water  of  ammonia.  Because  of  the  chemical  change  attending  the 
decolorization,  it  contains  no  free  iodine,  but  is  a  variable  mixture  containing  chiefly 
ammonium  iodide. 


CANTHARIS  67 

of  the  ear  in  treatment  of  severe  or  chronic  inflammations  about  the 
face  or  mouth.  It  should  be  rubbed  well  into  the  skin.  It  may  be 
mixed  with  equal  parts  of  tincture  of  iodine  for  combined  effect,  but 
about  the  head  it  will  generally  be  used  alone. 

Internally  the  oil  is  a  drastic  cathartic,  poisonous  in  very  moderate 
quantity,  thirty  minims  (2  mils.)  ha^'ing  caused  death.  In  the  usual 
dose  of  one-half  to  two  minims  (0.03-0.12  mil.)  it  irritates  the  intestinal 
tract,  producing  purging  in  from  one-haK  to  two  hours.  On  account 
of  its  prompt  action  it  is  often  given  for  revulsive  effect  in  cases  of 
cerebral  hemorrhage  or  inflammation,  and  in  uremic  poisoning.  Care 
must  be  taken  in  handling  croton  oil,  and  it  should  never  be  tasted. 

Cantharis. — Caxthaeides  (Spanish  Flies).— The  dried  insect,  Can- 
tharis  vesicatoria.  Obtained  in  various  European  countries,  the  large 
Russian  flies  being  preferred.     Average  dose  of  tincture,  mil  (0.10  mil.) 

As  a  counterirritant,  cantharis  is  used  in  the  form  of  the  cerate 
applied  as  a  plaster  to  the  skin  (Emplastrum  cantharidi.s) ,  or  the 
cantharidal  collodion,  which  is  applied  as  a  varnish. 

The  cerate  produces  in  about  twelve  hours  a  single  blister,  the  full 
size  of  the  application,  painful,  and  gi"ving  a  maximum  of  counter- 
irritant  effect.  Seldom  should  a  space  larger  than  one  by  three  inches 
be  covered.  Either  the  surface  of  the  plaster  or  the  skui  should  be 
oiled  before  applying,  to  ensure  acti^'ity  of  the  irritant  principle  can- 
tharidin,  which  is  soluble  in  oils. 

The  cantharidal  collodion  may  be  used  instead  of  the  cerate  for  ordi- 
nary application.  It  is  believed  to  be  safer,  and  it  is  much  more  con- 
venient. It  is  applied  as  any  other  collodion,  dries  quickly  and  requires 
no  dressing  until  the  blister  is  formed. 

There  is  some  danger  of  absorption  of  the  active  principle,  can- 
tharidin,  to  avoid  which  the  application  should  be  as  limited  as  pos- 
sible. Irritation  of  the  genito-urinary  tract  will  be  the  first  symptom 
of  its  poisonous  general  effect.  The  drug  is  reputed  to  be  aphrodisiac 
in  effect,  but  any  sexual  stimulation  is  due  to  irritation  and  is  only  one 
symptom  of  general  poisoning,  for  cantharis  is  an  irritant  poison  if 
taken  internally  in  excessive  dose.  The  tincture  is  the  preparation 
for  internal  use,  but  it  is  seldom  employed. 

In  case  of  poisoning  by  the  drug  in  bulk,  or  by  the  cerate,  no  oil 
should  be  used  as  a  demulcent,  because  of  the  solubility  of  the  active 
principle  in  oils. 

Chloroformum. — Chloroform. — This  drug  is  discussed  fully  in  the 
chapter  on  Anesthetics,  but  it  is  mentioned  here  on  account  of  its  irri- 


68  COUNTERIRRITANTS 

tant  local  action.  This  action  is  secured  best  when  the  vapor  is  con- 
fined. The  "  thimble  blister"  is  a  convenient  form  of  counterirritation 
when  it  is  to  be  limited  to  a  single  point.  It  is  produced  by  placing  a 
bit  of  cotton  saturated  with  chloroform  in  an  ordinary  thimble  and 
apjilying  it  closeh'  to  the  skin  for  five  to  ten  minutes. 

Treatment  of  Blisters. — Bearing  in  mind  that  the  healing  of  injured 
tissues  is  always  a  natural  process,  and  that  any  application  is  to  be 
regarded  only  as  an  aid,  the  simpler  we  make  the  treatment  of  blisters 
the  better.  This  involves  the  simple  principles  of  the  treatment  applied 
to  burns,  which  may  be  stated  as  follows: 

1.  Cleanliness. 

2.  Protection  from  air. 

3.  Stimulation  of  repair. 

The  first  is  self-evident  and  requires  only  the  simple  statement  that, 
as  simple  cleansing  applications,  any  but  the  mildest  antiseptics  should 
be  avoided.  Boiled  water,  normal  salt  solution,  and  sterilized  oils  or 
fats  answer  the  purpose  of  cleansing  a  blister  in  most  cases. 

In  the  absence  of  infection  it  is  unnecessary  to  disturb  the  blister  often, 
if  proper  protection  is  employed,  as  the  natural  process  of  healing  may 
be  disturbed  by  the  daily  removal  of  dressings,  particularly  when  they 
adhere.  Usually,  when  we  are  sure  that  the  blistered  surface  is  clean 
and  aseptic,  we  can  assume  that  healing  will  progress  without  interfer- 
ence. It  is  only  in  case  of  septic  or  unhealthy  conditions  that  frequent 
treatment  or  strong  applications  may  be  needed. 

The  second  is  accomplished  by  the  use  of  a  demulcent  such  as  a 
sterile  oil  or  fat,  or  by  any  non-irritating  protective  agent,  and  the 
api)lication  of  a  dressing  that  will  exclude  the  air.  The  contact  of 
air  is  usually  painful  from  its  drying  effect,  and  it  presents  also  the 
danger  of  infection  of  the  open  sore. 

Carron  oil*  is  a  time-honored  application  to  burns  and  blisters,  but 
an  objection  to  its  use  is  the  fact  that  the  drying  of  the  linseed  oil 
contained  in  it  makes  the  dressing  hard  and  often  difficult  to  remove 
without  disturbing  the  sore. 

The  third  applies  chiefly  to  large  blisters  that  heal  slowly,  and  includes 
such  measures  as  the  application  of  poultices  of  brewers'  yeast,  which 
is  a  most  excellent  cleansing  and  stimulating  agent,  f 

*  lAnimenlum  cnlcis,  composed  of  equal  parts  of  linseed  oil  and  lime-water, 
t  The  great  value  of  brewers'  yeast  in  cleansing  and  stimulating  repair  of  indolent 
and  foul  ulcers  is  believed  to  be  due  to  the  nuclein  developed  by  the  yeast  plant. 


TREATMENT  OF  BLISTERS  69 

When  healing  is  much  prolonged  and  hindered  by  the  development  of 
excessive  granulations  (proud  flesh),  the  latter  may  be  removed  by  a 
mild  caustic,  such  as  burnt  alum,  or  scraped  away.  Such  removal 
will  often  be  followed  by  more  rapid  healing.  The  last  resort  is  skin- 
grafting,  which  consists  in  transplanting  pieces  of  normal  skin  from 
some  other  part  of  the  body  upon  the  denuded  surface,  after  proper 
preparation.  This  will  usually  be  successful  in  securing  a  satisfactory 
epithelial  growth,  with  the  usual  cicatricial  healing  of  the  surface. 


CHAPTER  VII. 
ESCHAROTICS. 

Escharotics  or  caustics  are  agents  that  destroy  tissue  upon  contact. 
Many  attack  the  tissue  immediately  and  are,  therefore,  called  corrosives. 
.  It  will  be  noticed  that  nearly  all  agents  of  this  class  are  strong  chemi- 
cals; that  is  to  say,  they  are  known  and  characterized  by  j^owerful 
chemical  affinities.  And  this  fact  serves  to  explain  why  they  are  nearly 
all  corrosives.  They  have  so  great  affinity  for  one  or  more  constituents 
of  the  tissues  that  they  destroy  the  organic  structure  in  order  to  satisfy 
it.  It  is  further  noted  that  they  all  differ  somewhat  in  their  effects 
upon  tissue.  This  is  explained  by  their  difference  in  chemical  affinity.* 
Thus  carbolic  acid  has  a  strong  affinity  for  albuminous  matter;  it  cannot 
corrode  deeply  because  the  firm  coagulum  immediately  formed  prevents 
its  penetration.  Caustic  potash,  on  the  contrary,  has  no  affinity  for 
albumin,  forms  no  coagulum,  but  penetrates  deeply  into  the  tissue, 
displacing  weaker  bases  from  their  combinations.  It  also  possesses 
an  affinity  for  water.  These  affinities  suggest  the  antidotes  in  case  of 
poisoning  by  each.  The  antidote  to  carbolic  acid  will  be  albumin,  that 
to  caustic  potash  a  dilute  acid. 

In  the  practical  application  of  caustics  we  prefer  those  that  combine 
efficiency  and  safety,  with  action  self-limited  or  easily  controlled. 

The  strong  acids  and  alkalies  are  prominent,  forming  groups  that 
are  typical  as  to  the  nature  and  action  of  corrosives,  but  they  are  not 
usually  the  agents  of  choice  because  of  the  severity  of  their  effects. 

In  the  grouping  that  follows,  chemical  similarity,  rather  than  simi- 
larity of  action,  is  made  the  basis.  This  facilitates  the  study  of  chemical 
antidotes,  which  apply  as  well  to  groups  as  to  individual  substances. 
Some  agents  that  cannot  be  thus  grouped  are  considered  in  an  unclassi- 
fied list  and  their  chemical  relations  studied  separately. 

*  Experiment. — To  compare  the  coagulant  and  non-coagulant  action  of  caustics: 
Spread  the  white  of  an  egg  upon  a  pane  of  glass  lying  upon  a  dark  surface.  Place 
at  intervals  upon  the  albumen  a  drop  of  each  of  the  mineral  acids,  of  phenol,  and  of 
caustic  soda  or  potash.  Note  that  the  alkali  does  not  coagulate;  the  acids  and  the 
phenol  do,  but  the  coagula  formed  differ  in  firmness. 


MINERAL  ACIDS  71 

Mineral  Acids. 

Acidum  Hydrochloricum. — ^Hydrochloric  Acid  (Muriatic  Acid). — 
Contains  32  per  cent.,  by  weight,  of  absolute  hydrochloric  acid  [HCl]. 

Acidum  Nitricum. — Nitric  Acid  (Aqua  Fortis).^ — Contains  68  per 
cent.,  by  weight,  of  absolute  nitric  acid  [HNO3]. 

Acidum  Nitrohydrochloricum,  —  Nitrohydrochloric  Acid  (Nitro- 
muriatic  Acid,  Aqua  Regia) . — Consists  of  82  parts  of  hydrochloric  acid 
and  18  parts  of  nitric  acid. 

Acidum  Sulphuricum. — Sulphuric  Acid  (Oil  of  Vitriol). — Contains  not 
less  than  94  per  cent.,  by  weight,  of  absolute  sulphuric  acid  [H2SO4]. 

Applied  t-o  living  tissue  mineral  acids  all  coagulate  alhumin,  but  nitric 
acid  more  firmly  than  the  others.*  Sulphuric  acid  has  also  a  marked 
affinity  for  water,  and  is  accordingly  the  most  powerfully  corrosive, 
producing  an  effect  very  similar  to  an  ordinary  burn.  They  all  have 
so  great  an  affinity  for  bases  that  they  disorganize  the  tissues  in  order 
to  combine  with  them,  hence  their  extremely  poisonous  effects. 

The  strong  mineral  acids  are  seldom  applied  to  the  mucous  mem- 
brane because  of  the  severity  of  their  action.  Upon  the  skin  they  may 
be  applied  directly  to  warts,  for  the  removal  of  which  a  few  daily 
applications  usually  suffice.  For  this  purpose  nitric  acid  is  preferable, 
because  slightly  less  severe  in  action  than  the  others. 

These  acids  are  caustic  to  bone  as  well  as  to  soft  tissues,  on  account 
of  their  power  to  dissolve  the  earthy  salts  of  bone.  Accordingly,  nitric 
acid  has  sometimes  been  applied  to  small  foci  of  carious  bone  which 
were  not  accessible  for  removal.  Its  action  may  be  checked  at  any  time 
by  the  use  of  a  weak  alkali,  such  as  sodium  bicarbonate  solution  or 
lime  water,  which  should  be  injected  forcibly,  so  as  to  ensure  the  anti- 
dotal reaction  at  the  point  of  the  corrosive  action  of  the  acid,  which 
may  be  at  some  depth.  Employing  in  dental  practice  the  solvent 
power  of  these  acids  upon  mineral  salts,  they  are  sometimes  applied, 
slightly  diluted,  within  a  small  root  canal  to  aid  in  enlarging  the  same. 
They  act  more  rapidly  upon  partly  decomposed  than  upon  sound  den- 
tine. In  fact  the  normal  tooth  structure  seems  to  be  little  affected 
during  the  ordinary  time  of  application;  however,  when  the  action  has 
proceeded  as  far  as  is  desired  the  acid  should  be  completely  neutralized. 
The  range  of  strength  of  sulphuric  acid,  as  mostly  employed,  is  20  to 
50  per  cent.,  depending  upon  extent  of  action  required.  Caution  should 
be  used  to  prevent  its   passage   into  the  periapical  region,  for  there 

*  See  Experiment,  previous  page. 


72  ESCHAROTICS 

is  no  doubt  that  such  strong  agents  predispose  to  the  formation  of 
abscesses  by  lessening  the  resistance  to  infection. 

Internally  mineral  acids  are  employed  only  in  diluted  form.  They 
are  further  discussed  under  the  heading  of  Restorative  Tonics. 

Poisoning  by  Mineral  Acids. — When  a  strong  mineral  acid  is  used  for 
any  purpose,  it  must  be  borne  in  mind  that  it  is  a  dangerous  substance, 
and  great  care  must  be  exercised  to  guard  against  poisoning.  The 
bottle  should  be  labeled  with  a  poison-label,  such  as  pharmacists  are 
required  to  place  upon  all  powerful  poisons.  The  dentist  also  should 
have  a  ready  knowledge  of  first  treatment  in  case  of  poisoning;  for  any 
treatment,  to  be  of  use,  must  be  employed  very  promptly,  or  a  fatal 
result  may  be  expected.  In  the  presence  of  a  case  of  poisoning  by  a 
strong  mineral  acid,  it  is  not  essential  to  know  just  which  acid  has  been 
swallowed.  The  important  facts  upon  which  to  proceed  are:  (1)  that 
the  corrosive  action  depends  chiefly  upon  the  concentration  of  the  acid ; 
and  (2)  that  the  affinities  of  the  whole  group  are  so  nearly  identical  that 
the  same  antidotal  treatment  will  apply  to  all.  The  first  and  most 
important  thing  to  do  is  to  dihite  the  poison  freely  by  large  draughts  of 
water.  This  will  remove  the  danger  of  further  corrosion,  and,  as  water 
is  always  at  hand,  it  can  be  employed  immediately.  The  use  of  a 
chemical  antidote  must  be  secondary,  because  of  the  time  usually  neces- 
sary for  its  preparation,  during  which  serious  damage  is  being  done  by 
the  corrosive  poison  if  undiluted.  But  after  free  dilution  the  chemical 
antidote  should  be  given,  so  as  to  completely  neutralize  the  poison. 
An  alkali  \^ill  be  selected,  diluted  if  at  all  irritating,  and  given  freely. 
Lime-water  and  magnesia  are  preferred  to  a  carbonate,  because  the 
latter  will,  in  reaction  with  the  acid,  give  off  a  large  quantity  of  carbon 
dioxide  gas,  which  may  cause  painful  distention  of  the  stomach  and  even 
endanger  its  corroded  wall.  In  emergency,  soap,  or  plaster  scraped 
from  the  wall,  may  be  given.  Vomiting  generally  occurs,  and  washing 
out  of  the  stomach  is  facilitated  by  the  early  dilution  with  water  as 
recommended  above.  The  use  of  emetics  or  the  stomach  tube  is  open 
to  question  in  these  cases.  Since  the  neutralization  of  the  acids  with 
simple  alkalies  results  usually  in  harmless  products  it  seems  unneces- 
sary to  further  irritate  the  stomach.  Later  treatment  will  comprise 
the  use  of  demulcents,  anodynes  and  stimulants.  (See  Table  of  Poisons 
and  Antidotes.)  The  fact  that  poisoning  by  strong  mineral  acids  is 
usually  fatal,  demands  that  emphasis  be  placed  ui)()n  immediate  treat- 
ment, as  outlined. 


CAUSTIC  ALKALIES  73 


Organic  Acids. 


Acidum  Acetum  Glaciale. — Glacial  Acetic  Acid  [C2H4O2]. — Nearly 
or  quite  absolute  acetic  acid,  being  not  less  than  99  per  cent.  It  is 
liquid  or  crystalline,  according  to  the  external  temperature,  its  melting- 
point  being  a  little  below  60°  F.  It  is  colorless  and  has  a  strong  vine- 
gar-like odor  and  a  sharp  acid  taste.  It  is  not  a  coagulant,  but,  on  the 
contrary,  is  a  solvent  of  albuminous  and  fibrous  tissue.  It  is  employed 
only  as  a  caustic  and  to  soften  callous  tissue.     It  is  not  used  internally. 

Acidum  Trichloraceticrm. — Tkichloeacetic  Acid  [C1HO2CI3]. — It 
should  be  not  less  than  99  per  cent.  Obtained  by  oxidation  of  chloral 
hydrate  with  fuming  nitric  acid  and  subsequent  distillation,  it  occurs 
in  colorless  crystals  that  are  very  deliquescent.  It  is  soluble  in  0.1 
part  of  water  and  very  soluble  in  alcohol  and  ether.  Either  in  crystals 
or  strong  solution  it  is  used  as  a  caustic  to  remove  redundant  tissue, 
as  overhanging  gums,  warts,  etc.  It  coagulates  albumin,  and  may  be 
employed  as  a  test  for  that  substance.  A  20  per  cent,  solution  is  recom- 
mended as  an  application  to  chronic  inflammations  of  mucous  mem- 
branes. In  full  strength  it  may  be  applied  to  the  gum  tissue  to  prevent 
exudation  of  moisture,  the  so-called  "weeping  gums,"  during  filling  or 
setting  of  a  crown. 

In  the  treatment  of  pyorrhea  alveolaris  this  drug  may  be  applied  in 
from  90  per  cent,  down  to  5  per  cent,  strength — the  strongest  solution 
first,  as  a  powerful  escharotic,  and  the  strength  then  gradually  reduced 
to  that  which  is  astringent  and  antiseptic,  having  the  added  advantage 
in  any  strength  of  its  solvent  power  upon  the  calcareous  deposits.  It 
is  also  used  to  obtund  sensitive  dentine. 

.  Acidum  Lacticum. — Lactic  Acid. — A  colorless,  syrupy  liquid  contain- 
ing 85  to  90  per  cent,  of  absolute  lactic  acid  [CsHeOs].  It  is  obtained 
by  lactic  fermentation  of  milk-sugar  or  grape-sugar.  It  is  strongly 
acid  in  reaction,  freely  miscible  with  water,  alcohol,  or  ether;  insoluble 
in  chloroform.  It  does  not  coagulate  albumin,  but  may  be  employed  as 
a  solvent  to  fibrinous  exudates,  as  in  diphtheria,  a  20  per  cent,  solution 
being  applied.  A  solution  of  20  to  50  per  cent,  may  be  used  in  the 
treatment  of  pyorrhea  alveolaris  to  soften  remnants  of  calcular}^  deposit 
in  the  tooth  socket. 

Caustic  Alkalies. 

Aqua  Ammoniae  Fortior. — Stronger  Water  of  Ammonia. — A  28  per 
cent,  solution,  by  weight,  of  ammonia  gas  [NH3]  in  water.     This  solu- 


74  ESCHAROTICS 

tion  is  not  used  medicinally  to  any  extent,  but  it  is  the  basis  for  the 
preparation  of  spirit  of  ammonia.  It  is  a  volatile  caustic,  the  vapor 
being  extremely  irritating  to  the  air  passages.  The  United  States 
Pharmacopoeia  directs  that  it  should  be  kept  in  strong,  glass-stoppered 
bottles,  not  completely  filled,  in  a  cool  place.  The  bottle  should  be 
opened  cautiously  ^vith  its  mouth  directed  away  from  the  face;  and  if 
the  temperature  is  warm,  the  bottle  had  better  be  cooled  before  opening, 
as  otherwise  the  gas  may  be  under  considerable  pressure.  In  case  of 
accidental  swallowing  of  this  caustic,  sjinptoms  of  irritation  of  the 
respiratory  tract,  with  dyspnea,  will  be  prominent.  This  will  call  for  a 
volatile  antidote  in  addition  to  the  free  dilution  of  the  poison  by  water. 
The  proper  antidote  will  be  the  vapor  of  strong  acetic  acid,  in  the 
absence  of  which  strong  vinegar  may  be  swallowed  and  its  vapor  inhaled. 
Stronger  water  of  ammonia  is  a  powerful  saponifying  agent.  It  does 
not  coagulate  albumin.  The  ordinary  water  of  ammonia  (10  per  cent.) 
may  be  prepared  from  this  stronger  solution  by  diluting  with  twice  its 
volume  of  water. 

Potassii  Hydroxidum. — Caustic  Potash. — Potassa. — Potassium  Hy- 
drate [KOH]. — 85  per  cent,  at  least. 

Sodii  Hydroxidum. — Caustic  Soda. — Soda. — Sodium  Hydrate  [NaOH]. 
— 90  per  cent,  at  least. 

Potassa  and  soda  are  the  only  caustic  alkalies  used  in  dental  practice, 
and  these  very  seldom.  They  are  prepared  in  form  of  sticks,  which  deli- 
quesce readily  and  must,  therefore,  be  kept  in  tightly-corked  bottles 
and  must  not  be  handled  without  protection  of  the  fingers.  Their 
affinities  are  for  water  and  acids.  They  do  not  coagulate  albumin,  there- 
fore their  penetration  is  unhindered.  They  corrode  deeply,  causing 
severe  pain.  They  are  in  no  respect  superior  to  iodine  and  carbolic 
acid  as  superficial  caustics,  and  accordingly  have  little  to  recommend 
them  at  the  present  time.  Their  action  is  more  easily  controlled  than 
that  of  arsenic,  as  they  can  be  completely  neutralized  by  weak  acids. 
They  may  be  useful  in  the  place  of  arsenic  for  the  removal  of  small 
tumors. 

In  poisoning  by  one  of  the  caustic  alkalies  the  usual  rule  of  giving 
water  freely  to  dilute  the  poison  applies,  with  the  additional  advantage 
that  water  satisfies  one  of  the  affinities  of  either  soda  or  potassa.  The 
chemical  antidote  to  follow  dilution  is  any  dilute  acid,  giving  prefer- 
ence to  the  less  irritating  vegetable  acids,  such  as  vinegar  and  lemon 
juice.  (See  Table  of  Poisons  and  Antidotes.)  While  only  the  strong 
alkalies  are  classed  as  escharotics,  even  the  dilute  solutions  known  as 


UNCLASSIFIED  ESCHAROTICS  75 

liquor  potassii  hydroxidi  and  liquor  sodii  hydroxidi  (not  less  than  4.5 
per  cent.)  are  decidedly  caustic  and  irritating  to  mucous  membranes. 
As  an  alkali  soda  is  slightly  stronger  than  potassa.  Both  are  powerful 
saponijQers. 

Unclassified  Escharotics. 

Phenol. — Carbolic  Acid  [CeHaOH]. — Hydroxybenzene  obtained  from 
coal-tar  or  made  synthetically,  being  of  not  less  than  97  per  cent, 
strength.     The  average  internal  dose  is  1  grain  (0.06  gm.)  well  diluted. 

Phenol  Liquef actum. — Liquefied  Phenol. — 87  per  cent. 

[Crude  jjhenol  is  a  liquid  consisting  of  various  constituents  of  coal- 
tar,  having  an  odor  resembling  that  of  creosote.  It  is  used  only  as  a 
general  disinfectant,  never  internally  as  a  medicine.] 

Phenol  was  discovered  in  1834  by  Runge,  who  gave  it  the  name  of 
carbolic  acid.  In  chemical  nature  this  substance  is  not  an  acid,  but  an 
alcohol,  the  term  "acid"  having  been  given  to  it  probably  on  account 
of  its  corrosive  action.  It  is  only  slightly  acid  to  test-paper,  and  while 
it  combines  with  a  few  bases,  the  resulting  salts  are  so  unstable  as  to 
be  decomposed  by  carbonic  acid.  It  is  not  capable  of  neutralizing 
alkalies.  It  is  a  definite,  crystalline  compound,  with  a  distinct, 
sweetish  odor,  soluble  in  about  15  parts  of  water,  very  soluble  in 
alcohol,  glycerin,  ether,  chloroform  and  oils.  The  crystals  liquefy  easily 
in  a  warm  temperature,  and  reform  when  the  liquid  is  cooled;  but  a 
permanent  liquid  form  may  be  secured  by  the  addition  of  5  to  10  per 
cent,  of  water  or  glycerin.  By  exposure  the  liquefied  drug  gradually 
acquires  a  pinkish  and  later  a  reddish  or  brownish  color,  which  does  not 
lessen  its  value. 

According  to  Demant,*  the  color  of  phenol  may  be  removed,  and 
perfectly  white  crystals  again  obtained,  by  adding  11  parts  of  alcohol 
to  89  parts  of  the  phenol,  subjecting  the  mixture  to  freezing,  and  then 
draining  off  the  portion  remaining  liquid. 

As  a  caustic  this  drug  differs  from  all  others  in  having  a  local  analgesic 
effect  following  a  momentary  irritation.  Its  most  decided  affinity  is 
for  albumin,  which  it  coagulates  quicliy  and  firmly,  thus  limiting  pene- 
tration beyond  the  superficial  layer  of   tissue,  f     Its  analgesic  effect, 

*  United  States  Dispensatory,  eighteenth  edition,  p.  .37. 

t  Experiment. — To  show  the  effect  of  phenol  upon  mucous  membrane  and  the 
restorative  effect  of  alcohol :  Evert  the  lower  hp  and,  after  drying,  touch  two  sepa- 
rate points  each  with  the  quantity  of  phenol  that  will  adhere  to  the  head  of  a  pin. 
See  the  white  coagulum  form  at  each  point.  After  half  a  minute  dry  the  surface 
and  apply  a  few  drops  of  alcohol  to  one  coagulum.  Xote  the  difference  in  the  two 
points  after  a  few  minutes.     Also  observe  the  results  next  day. 


76  ESCHAROTICS 

combined  uitli  a  superficial  but  decided  corrosive  action,  makes  it  an 
ideal  caustic  for  limited  ai)plication  to  a  mucous  membrane.  Extensi\'e 
application  might,  indeed,  cause  inflammation  and  symptoms  of  poison- 
ing, and  must  be  avoided.  Upon  the  skin  the  action  is  less  energetic, 
although  still  quite  caustic  where  the  skin  is  soft  or  thin.  In  case  of 
accidental  contact  uith  tissues,  the  effect  may  be  mitigated  by  the 
immediate  application  of  alcohol,  as  explained  later  in  the  discussion 
of  poisoning. 

The  drug  may  be  applied  pure  to  ulcerated  or  denuded  points,  whether 
painful  or  not,  ^  ith  the  result  that  any  septic  process  present  will  be 
antagonized,  and  the  coagulum  formed  will  protect  exposed  nerve 
endings.  Thus  applied  to  canker  sores,  it  will  relieve  the  pain  for  a 
considerable  time  and  check  the  bacterial  activity.  The  sore  should 
first  l>e  dried  and  just  sufficient  of  the  pure  drug  applied  to  cover  well 
the  ulcer.     Several  daily  applications  may  be  needed  for  complete  relief. 

Carbolic  acid  is  not  an  efficient  devitalizing  agent,  because  it  does  not 
penetrate,  and  its  superficial  effect  is  not  sufficiently  irritating  to  induce 
engorgement  of  the  deeper  tissues.  Only  in  deciduous  teeth  is  carbolic 
acid  made  use  of  as  a  pulp  devitalizer.  Here  a  slovver  effect  occurs 
from  repeated  ajiplications,  without  the  pain  that  may  attend  the  use 
of  arsenic  and  without  any  danger  of  systemic  disturbance. 

For  disinfecting  alveolar  abscess  and  stimulating  repair,  a  small 
quantity  of  pure  phenol  upon  a  pledget  of  cotton  may  be  introduced 
after  the  abscess  has  been  evacuated;  or,  in  suitable  cases,  it  may  be 
pumped  through  the  apex  of  the  root  into  a  pus  tract  and  through  a 
fistulous  opening. 

It  is  frequently  used  as  a  pulp  dressing  in  case  of  toothache  from 
exposure  of  pulp,  but  never  \\  hen  the  pulp  is  to  be  conserved,  on  account 
of  its  destructive  action  upon  it.  It  may  also  be  applied  to  obtund 
sensitive  dentine.  It  has  been  used  to  lessen  the  sensitiveness  of  the 
gums  in  order  to  apply  a  rubber-dam  ligature  far  beyond  the  gum  margin. 
But  for  this,  as  for  nearly  ever}'  purpose  as  an  analgesic,  it  is  inferior 
to  cocaine,  and  has  the  further  disadvantage  of  always  destroying  some 
tissue  when  applied  strong. 

The  uses  discussed  thus  far  apply  to  the  pure  carbolic  acid  or  a  slight 
dilution  of  it.  But  the  most  important  place  of  this  substance  in  medi- 
cine is  as  an  antiseptic,  under  which  heading  will  be  discussed  its  more 
general  uses  in  diluted  solutions. 

Poisoning  by  Phenol. — The  poisonous  poA\er  of  this  drug  is  very  great, 
as  the  recently  immerous  deaths  by   suicide  show.     The  s^Tnptoms 


UNCLASSIFIED  ESCHAROTICS  77 

of  poisoning  combine  those  of  local  injury  to  the  lining  of  the  digestive 
tract,  with  shock  and  great  depression  of  the  nervous  system,  the  latter 
often  leading  to  death  within  an  hour.  The  antidotes  are  albumin  in 
the  form  of  raw  egg,  or  milk  or  flour  paste  as  substitutes  for  it,  and 
alcohol.  Albumin  furnishes  material  for  the  poison  to  act  upon  and 
expend  its  corrosive  po^er  in  coagulation.  It  must  be  given  early  to 
be  of  use.  It  is  a  true  chemical  antidote.  Alcohol  is  employed  in 
phenol  poisoning  but  it  is  not  a  chemical  antidote.  It  seems  to  act 
upon  the  corroded  tissue,  lessening  the  destruction  that  would  follow, 
its  action  being  physiological  rather  than  chemical. 

It  has  been  found  that  the  hands  may  be  immersed  in  pure  liquid 
carbolic  acid,  and,  if  washed  immediately  afterward  in  strong  alcohol, 
no  harm  to  the  tissues  will  result.  Also,  if  carbolic  acid  be  applied 
to  the  mucous  membrane  with  the  production  of  the  white,  superficial 
coagulum,  and  strong  alcohol  be  then  applied,  the  white  spot  will 
partly  disappear  and  the  corrosive  action  be  much  diminished.*  An 
explanation  of  this  antidotal  influence  of  alcohol  is  found  in  its  affinity 
for  water,  which  it  draws  toward  the  surface,  thereby  furnishing  more 
fluid  for  redissolving  the  coagulum  and  diluting  any  uncombined  car- 
bolic acid  that  may  be  present  in  the  tissue.  (See  Table  of  Poisons 
and  Antidotes.) 

The  poisonous  effects  of  phenol  are  not  limited  to  its  local  action 
upon  tissue,  t  When  it  is  absorbed  in  considerable  quantity  it  gives 
rise  to  irritating  products  which  may  seriously  damage  the  kidneys, 
liver  and  other  organs.  Fatty  degeneration  of  various  tissues  has  often 
been  found  postmortem.  Corresponding  to  this  action  the  urine  in 
phenol  poisoning  often  shows  an  olive-green  or  dark  color.  To  counter- 
act the  systemic  poisonous  action  it  is  advised  that  a  soluble  sulphate 
be  given  for  some  time,  so  that  harmless  combinations  may  be  formed 
and  eliminated;  but  the  value  of  this  treatment  has  been  questioned, 
and  by  some  authorities  believed  to  have  been  disproved. 

*  See  Experiment,  p.  75  (note). 

t  In  the  Philadelphia  Medical  Times,  vol.  xi,  p.  284,  Taylor  records  a  case  in 
which  a  man,  who  was  supposed  to  have  swallowed  about  1  ounce  of  carbohc  acid, 
became  comatose  within  three  minutes  and  died  within  four  minutes  from  the  time 
of  taking  the  poison. 

In  the  New  York  Medical  Journal,  November  30,  1889,  Richardson  reports  a 
case  in  which  equal  parts  of  carbolic  acid  and  sweet  oil,  apphed  to  a  burn  on  the  arm 
of  a  child  seven  months  old,  caused  stupor  in  two  hours,  and  death  occurred,  with 
convulsions,  thirty  hours  after  the  appUcation. 

Death  has  followed  the  application  to  the  skin  of  half  an  ounce  of  carbohc  acid 
in  watery  solution,  for  the  purpose  of  destroying  parasites. — Wood's  Therapeutics, 
eleventh  edition,  p.  563. 


78  ESCHAROTICS 

Several  combinations  of  phenol  deserve  mention  because  of  their 
modified  action,  which  is  at  times  desirable: 

Camphorated  phenol,  or  campho-phenique,  consists  of  about  equal 
parts  of  camphor  and  phenol,  which  liquefy  when  heated  together.  It 
is  less  soluble  than  phenol,  and  it  does  not  corrode  tissue.  Used  chiefly 
as  a  disinfectant  canal  dressing  and  as  an  obtundent. 

JAquor  sodii  carholatis  contains  50  per  cent,  phenol  (see  formula,  p. 
128).  It  is  somewhat  caustic  if  used  in  full  strength.  It  provides  a 
strongly  alkaline  application  for  limited  use  as  a  disinfectant. 

Chloral-phenol,  prepared  by  triturating  together  with  heat,  1  part 
chloral  hydrate  and  3  parts  phenol.  The  product  is  an  oily  liquid 
which  may  be  used  as  counterirritant  and  local  analgesic. 

Iodized  phenol,  consisting  of  a  mixture  of  iodine  and  phenol  in  vary- 
ing proportions,  whereby  the  irritant  property  is  increased.  Equal 
parts  of  tincture  of  iodine  and  phenol  is  sometimes  used  as  a  counter- 
irritant. 

Argenti  Nitras.^ — Nitrate  of  Silver  [AgXOs]. — Dose,  gr.  |  (0.01  gm.). 

Argenti  Nitras  Fusus. — Moulded  Nitrate  of  Silver. — Lunar  Caus- 
tic.— ]\Ioulded  sticks  containing  about  95  per  cent,  of  silver  nitrate. 

Argenti  Nitras  Mitigatus. — Diluted  Nitil^te  of  Silver. — Mitigated 
Caustic. — IMoulded  sticks  consisting  of  1  part  silver  nitrate  and  2  parts 
potassium  nitrate.     (Not  official.) 

Nitrate  of  silver  occurs  primarily  in  colorless  crystals,  having  a  bitter, 
metallic,  and  somewhat  caustic  taste.  Its  aqueous  solutions  are  neutral. 
From  the  crystals  are  prepared  the  moulded  and  diluted  forms,  which 
are  in  pencils  or  sticks  convenient  for  application.  All  forms  are  freely 
soluble  in  water,  the  pure  salt  being  soluble  in  0.4  })art  and  in  30  parts 
of  alcohol. 

This  drug  in  any  form  or  strength  of  solution  turns  dark  upon 
exposure  to  sunlight.  This  is  a  standing  objection  to  its  use  about  the 
face,  and  especially  about  a  carious  tooth,  the  structure  of  which  it 
may  stain  permanently  if  allowed  to  penetrate  the  dentinal  tubuli. 

A  stain  upon  the  skin  remains  until  the  stained  epithelium  is  Avorn 
away.  It  cannot  be  removed  sooner  except  by  paring  or  scraping 
away  the  superficial  layer,  but  the  stain  upon  a  fabric  may  be  easily 
removed  by  a  weak  solution  of  potassium  cyanide.  The  prolonged 
internal  use  of  silver  in  any  form  may  cause  a  permanent  blueness  of 
the  skin  called  argyria. 

As  a  caustic  its  action  depends  upon  its  affinity  for  albumin,  it  being 
a  decided  coagulant.     Its  application  causes  an  irritation  that  continues 


UNCLASSIFIED  ESCHAROTICS  79 

for  some  time,  but  the  effect  is  quite  superficial  because  of  the  coaguhim 
formed,  which  hinders  penetration.  It  has  long  been  used  to  cauterize 
wounds  that  are  probably  infected,  such  as  dog  bites  and  dissection 
wounds,  but  it  must  be  regarded  as  poorly  adapted  to  this  use.  It  does 
not  penetrate  deeply,  therefore  cannot  be  relied  upon  to  destroy  the 
infected  tissue,  and  it,  moreover,  by  coagulating  the  surface,  checks 
hemorrhage  that  might  be  useful  in  washing  away  the  infectious  matter, 
and  it  seals  in,  as  it  were,  the  point  of  infection.  Its  use,  therefore, 
as  a  cauterant  for  deep,  infected  wounds  must  be  condemned. 

It  is  one  of  the  most  irritating  caustics  to  the  mucous  membrane,  on 
account  of  the  added  effect  of  a  small  amount  of  nitric  acid  liberated 
by  the  coagulant  reaction. 

The  field  of  usefulness  of  this  drug  is  for  superficial  effect  upon  invis- 
ible surfaces,  where  it  is  desired  to  have  the  irritation  pronounced  or 
productive  of  a  secondary  stimulation  of  the  local  circulation.  Accord- 
ing to  the  degree  of  action  desired  it  may  be  applied  in  the  pure  stick 
of  lunar  caustic,  the  stick  of  mitigated  caustic,  or  in  aqueous  solution 
of  1  to  10  per  cent,  strength,  the  weaker  solutions  being  astringent 
rather  than  caustic.  It  is  frequently  applied  to  abort  acute  inflamma- 
tions and  as  a  stimulating  caustic  to  indolent  ulcers. 

In  dental  practice  silver  nitrate  is  used  to  check  caries  in  temporary 
teeth,  where  fifling  is  impracticable.  It  was  fir-st  recommended  for 
this  purpose  by  S.  Stebbins,  in  1891.  Szabo,  of  Budapest,  has  made 
the  most  extensive  scientific  study  of  this  action.  He  found  by  experi- 
ments that: 

1.  It  penetrates  one-half  milluneter  (5V  oi  an  inch)  into  the  dentine. 

2.  The  albumin  unites  with  the  metallic  salt  in  form  of  a  precip- 
itate. 

3.  Granular  albuminate  is  formed  which  the  action  of  light  darkens. 

4.  It  finally  becomes  black  and  insoluble. 

For  the  purpose  stated  it  is  applied  either  in  pure  form,  or  in  satur- 
ated aqueous  solution,  at  the  point  of  decay.  The  fused  stick  may  be 
employed,  or  some  of  the  crystal  may  be  melted  upon  a  heated  plati- 
'num  point  and  carried  to  the  tooth,  as  recommended  by  Craven;  or  a 
silver  wire  dipped  in  nitric  acid  may  be  used.  Holmes*  advises,  for 
approximal  cavities,  to  carry  the  powdered  crystal  adhering  to  a  piece 
of  gutta-percha,  which  has  been  softened  by  heat,  of  proper  size  to 
remain  in  the  cavity.  The  silver  nitrate  is  thus  retained  for  a  long 
time. 

*  Dental  Cosmos,  1892,  p.  982. 


80  ESCHAROTICS 

Because  of  its  coagulant  power  it  may  also  be  used  to  obtund  sensitive 
dentine  in  cavities  that  are  not  visible,  where  the  staining  would  be 
less  objectionable.  Its  distinctive  antiseptic  value  is  discussed  inider 
Antiseptics, 

Incompatihility. — With  alhumhums  matter  coagulation  occurs;  with 
hydrochloric  acid,  soluble  chlorides,  or  chlorine  solutions,  a  precipitate 
of  chloride  of  silver  occurs;  in  contact  with  most  metals  it  is  reduced 
to  metallic  silver;  an  aqueous  solution  acidulated  with  nitric  acid  and 
heated  with  alcohol  will  form  the  explosive  "fulminating  silver." 

In  poisoning  by  silver  nitrate  the  chemical  antidotes  are  albumin 
and  sodium  chloride.  The  latter  forms  ^^'ith  it  the  insoluble  chloride  of 
silver.  In  case  of  the  use  of  the  drug  locally  any  excess  may  be  at 
once  removed  by  sodium  chloride  solution.  (See  Table  of  Poisons  and 
Antidotes.) 

Hydrogen  dioxide  [H2O2],  in  very  strong  ethereal  solution  (25  per 
cent.),  is  a  caustic,  but  its  uses  as  such  have  not  been  very  definitely 
developed  as  yet.  It  is  used  chiefly  as  a  bleaching  agent.  Care  must 
be  taken  in  handling  this  strong  solution  to  avoid  its  action  upon  the 
hands.     Oiling  will  protect  the  skin  from  its  action. 

Alumen  Exsiccatum. — Dried  Alum. — Burnt  Alum  [i\lK(S04)2]. 
Alum,  by  being  deprived  of  its  water  of  crystallization,  is  changed  from 
an  astringent  to  a  mild  caustic.  It  has  little  influence  upon  firmly 
organized  tissue.  It  is  used  chiefly  to  destroy  excessive  granulations  in 
wounds  or  ulcers,  the  so-called  "proud  flesh."  The  powder  is  applied 
directly. 

Cupri  Sulphas. — Sulphate  of  Copper. — Blue  Vitriol  [CUSO4+5H2O]. 
Ks,  a  mild  caustic  the  pure  crystal  may  be  api)lied  to  mucous  mem- 
branes, the  typical  condition  for  its  use  being  found  in  granular  eyelids. 
It  is  acid  in  reaction.  In  strong  aqueous  solution  it  has  been  applied 
to  pyorrheal  pockets,  but  here  it  is  an  inferior  agent  because  of  the 
danger  of  discoloring  the  root  and  tooth.  It  is  likewise  astringent, 
and  is  more  fully  considered  in  that  relation.  (See  under  Astringents, 
also  Table  of  Poisons  and  Antidotes.) 

Chromii  Trioxidum. — Chromic  Anhydride. — Chromic  Acid  [CrO,i]. 
It  occurs  in  purplish-red  crystals,  which  are  soluble  and  deliquescent, 
forming  chromic  acid.  Alcohol  decomposes  it  sometimes  with  explosive 
violence.     It  is  an  energetic  caustic,  but  rarely  used. 

Zinci  Chloridum. — Chloride  of  Zinc  [ZnCl2]. 

This  substance  occurs  in  white  powder,  or  in  irregular  masses  or 
fused  sticks,  all  of  ^^'hich  are  intensely  caustic  and  dangerous  to  taste, 


UNCLASSIFIED  ESCHAROTICS  81 

and  acid  in  reaction.  The  salt  is  very  deliquescent,  therefore  the  drug 
may  commonly  be  in  either  solid  or  liquid  form.  It  is  soluble  in  0.3  part 
of  water  and  very  soluble  in  alcohol.  Used  pure  it  is  a  very  energetic 
caustic.  Its  affinities  are  for  water  and  albumin,  therefore  its  action  is 
prompt,  producing  a  firm,  white  eschar.  It  is  held  to  be  the  most 
penetrating  of  all  coagulants.  The  official  liquor  zinci  chloridi  (50  per 
cent.)  may  be  employed,  or  a  stronger  solution  prepared,  as  a  pene- 
trating coagulant  anient  within  the  structure  of  the  tooth.  After  removal 
of  the  pulp  it  will  efficiently  disinfect  and  coagulate  the  contents  of  the 
tubuli.  Indeed,  in  the  stronger  solutions,  it  is  used  more  in  treating 
tooth  structure  than  soft  tissues,  on  account  of  the  pain  attending  its 
action  upon  the  latter. 

It  has  long  been  used  in  full  strength  to  lessen  the  sensitiveness  of 
dentine.  Its  action  is  not  a  simple  one,  but  is  based  upon  its  affiaity 
for  water,  and  its  coagulant  power,  to  which  is  added  the  irritant  influ- 
ence of  a  small  quantity  of  hydrochloric  acid  liberated  in  the  coagulant 
reaction.  Care  must  be  taken  not  to  apply  it  so  near  the  pulp  as  to 
produce  irritation;  and  repeated  applications  may  be  needed  as  exca- 
vation proceeds.  When  irritation  of  the  pulp  is  feared  from  its  use,  the 
cavity  should  be  at  once  irrigated  with  tepid  water.  It  is  one  of  the 
agents  used  to  cauterize  and  stimulate  the  closure  of  alveolar  pockets 
about  the  roots  of  teeth  in  cases  of  recession  or  pyorrhea. 

In"  addition  to  its  other  dental  uses,  it  is  very  effective  in  the  treat- 
ment of  chronic  aiveolar  abscess.  It  should  be  applied  directly  to  the 
abscess  cavity  thrbugh  the  root  canal  or  through  an  external  opening.  It 
is  very  painful  for  a  short  time  when  first  applied.  In  addition  to  its 
escharotic  action  it  produces  considerable  irritation,  thereby  setting 
up  an  active  inflammatory  process  which  hastens  resolution.  For  this 
purpose  it  may  be  used  in  a  solution  varying  in  strength  from  10  to  50 
per  cent. 

The  following  is  recommended  when  the  aqueous  solution  proves 
very  painful:* 


Gm.  or  mil. 

I^ — Zinci  chloridi 2 

Alcoholis, 

Chloroformi aa     15 


60  (gr.  xl). 


(fgss).— M. 
(Hofheinz.) 


In  the  weaker  solutions  (1  to  20  per  cent.)  it  is  astringent  and  anti- 
septic, and  further  discussion  of  its  uses  will  occur  in  the  chapters  devoted 
to  those  classes  of  agents. 

*  Dental  Cosmos,  1903,  p.  31. 


82  ESCHAROTICS 

It  must  be  ranked  as  a  corrosive  poison.  The  preparations  likely 
to  cause  poisoning  are  the  full  strength  liquid,  the  50  per  cent,  solution, 
and  the  popular  "Burnett's  disinfecting  fluid,"  which  contains  200 
grains  to  the  fluidounce  (about  42  per  cent.)-  The  chemical  antidotes 
are  albumin  and  dilute  solution  of  sodium  or  j)otassium  carbonate.  (See 
Table  of  Poisons  and  Antidotes.) 

Incompatibility. — The  drug  is  incompatible  with  the  antidotes  men- 
tioned above  and  with  nitraie  of  silver. 

Chloride  of  zinc  in  its  liquid  form  enters  into  the  formation  of  the 
oxychloride  of  zinc  filling  cement. 

Arseni  Trioxidum. — ^White  Arsenic. — Arsenous  Acid  [AS2O3] .  Average 
dose,  gr.  ^V  (0-002  gm.). 

Following  the  U.  S.  P.  description,  arsenic  is  a  heavy  solid,  occurring 
"  either  as  an  opaque  white  powder,  or  in  irregular  masses  of  two  varie- 
ties: one  amorphous,  transparent  and  colorless,  like  glass;  the  other 
crystalline,  opaque  and  white,  resembling  porcelain.  Contact  with 
moist  air  gradually  changes  the  glassy  into  the  white,  opaque  variety. 
Both  are  odorless  and  tasteless."* 

"In  cold  water  both  varieties  dissolve  very  slowly,  the  glassy  variety 
requiring  about  30,  the  porcelain-like  about  100  parts  of  water  at  25°  C. 
(77°  F.).  Both  are  slowly  but  completely  soluble  in  15  parts  of  boiling 
water.  In  alcohol,  arsenic  trioxide  is  sparingly  soluble,  but  it  is  soluble 
in  about  5  parts  of  glycerin."  An  aqueous  solution  is  only  faintly  acid 
in  reaction. 

Wherever  the  term  "arsenic"  is  used  in  the  following  pages  it  stands 
for  the  official  arsenic  trioxide.  The  characteristic  action  of  the  drug  is 
due  to  the  ion  of  arsenous  acid  and  not  to  the  element  arsenic,  which 
is  insoluble  in  water. 

(The  relations  of  the  drug  as  a  caustic  only  will  be  treated  at  this 
place.     For  its  internal  uses,  see  under  Alteratives.) 

Arsenic  stands  alone  in  its  characteristics  as  an  escharotic.  The  dry 
powder  may  be  placed  on  the  tongue  and  allowed  to  remain  for  one 
minute  without  causing  the  slightest  irritation  and,  if  then  thoroughly 
removed,  without  producing  any  effect  upon  the  tissues.  On  the 
contrary,  if  it  is  allowed  to  remain  until  it  becomes  dissolved  and  pene- 
trates the  tissues,  extensive  sloughing  will  result.  It  cannot  be  called 
an  irritant.  It  is  not  a  corrosive.  It  has  no  decided  chemical  affinities; 
therefore,  it  is  not  escharotic  b}^  reason  of  any  apparent  chemical  action. 

*  United  States  Pharmacopcria,  eighth  revision. 


UNCLASSIFIED  ESCHAROTICS  83 

It  stands  by  itself  as  a  vital  or  alterative  eschar  otic,  in  that  it  acts  only 
after  being  absorbed  by  the  tissue  elements,  altering  or  destroying  their 
vital  processes  in  an  obscure  manner.  Because  of  this  action  it  is 
difficult,  if  not  impossible,  to  limit  or  antagonize  its  influence  upon  the 
tissues  which  it  has  penetrated;  and  its  penetration  is  not  lunited  by 
any  action  of  its  own.  The  fact  of  its  being  tasteless  and  non-irritating 
at  first,  renders  its  use  about  the  mouth  the  more  dangerous,  for  by 
careless  handling  it  may  become  lodged  about  the  teeth  or  beneath 
the  edges  of  the  gum,' and  its  presence  be  not  appreciated  for  hours, 
until  devitalization  of  the  tissue  has  begun.  It  does  not  coagulate 
albumin. 

The  drug  acts  slowly,  penetrates  deeply,  and  destroys  tissue  exten- 
sively. It  seems  to  affect  abnormal  or  unorganized  tissue  elements,  as 
in  cancer,  more  readily  than  normal  tissue;  hence  its  use  in  the  removal 
of  abnormal  growths.  As  an  escharotic  it  is  always  used  in  its  pure 
form,  although  often  mixed  with  other  agents  for  convenience  of  appli- 
cation or  to  mitigate  its  action. 

The  medicinal  solutions  officially  prepared  from  it  are  all  for  inter- 
nal use,  to  secure  the  general  tonic  and  alterative  effects  of  the  drug. 
Therfore,  when  we  speak  of  applying  arsenic  locally  we  mean  always 
arsenic  trioxide  in  powder  form  or  in  mixture.     (See  Alteratives.) 

Dental  Use. — It  is  rare  that  arsenic  is  used  in  the  mouth  for  any  other 
purpose  than  devitalizing  pulps  of  teeth;  and  it  may  be  ^aid  today, 
after  more  than  half  a  century  of  experience  with  it  and  with  other 
less  dangerous  but  less  efficient  devitalizants,  that  it  is  the  substance 
of  first  choice  for  this  purpose.  It  is  only  with  deciduous  teeth  that 
a  less  powerful  agent  must  be  chosen.  Here  the  danger  would  be 
penetration  of  the  arsenic  through  and  beyond  the  apex  of  the  root,  with 
a  corresponding  extension  of  its  destructive  action. 

With  the  exception  noted,  it  is  true  generally  that  nothing  need  be 
feared,  in  the  way  of  extension  of  its  action,  when  the  drug  is  care- 
fully used  upon  the  tooth  pulp.  The  natural  confines  of  the  pulp  cavity 
and  root  canal  prevent  its  penetration  to  other  tissues,  so  that  only 
careless  handling  and  inappropriate  or  excessive  use  need  be  followed 
by  bad  results.  While  we  must  admit  the  possibility  of  irritation 
extending  beyond  the  pulp  chamber  in  case  of  a  good-sized  apical  fora- 
men, a  septic  inflammation  could  not  be  expected  from  the  action  of 
the  arsenic,  itself  being  a  strong  antiseptic. 

Careful  use  of  the  drug  implies  (1)  isolation  of  the  tooth  to  be  treated, 
by  applying  the  rubber  dam;  (2)  the  use  of  a  small  amount  of  the  drug; 


84  ESCHAROTICS 

(3)  careful  sealing-in  during  the  period  of  its  action;  and  (4)  its  thorough 
removal  after  de^•italization  is  complete. 

Hofheinz  formulates  the  following  rules  for  the  application  of  arsenic 
to  a  pulp : 

1.  Do  not  combine  it  with  an  escharotic. 

2.  Never  use  it  in  deciduous  teeth. 

3.  Do  not  place  it  over  an  aching  pulp. 

4.  Place  it  directly  on  the  pulp. 

o.  Exert  no  pressure  upon  the  pulp. 
'  6.  Never  crowd  it  into  root  canals. 

7.  Take  special  care  of  the  gum  tissues  if  the  cavity  is  near  the 
gingival  line. 

8.  Let  it  remain  twenty-four  hours  at  least. 

With  the  small  amount  necessary  to  destroy  a  pulp,  systemic  effects 
will  never  occur.  The  ordinary  medicinal  dose  of  arsenic  is  from  ^q 
to  tV  of  a  grain,  which  need  never  be  exceeded  for  this  use;  according 
to  jMiller  from  y'Wo  to  2^5  is  sufficient.  It  should  be  impressed  upon 
the  mind  of  the  practitioner  that  any  untoward  effects  that  may  follow 
his  emplo^inent  of  arsenic  in  a  tooth  \\  ill  be  purely  local  and  the  result 
of  either  ^ant  of  care  in  its  application  or  lack  of  judgment  as  to  its 
appropriateness . 

The  precise  mode  of  action  of  this  drug  as  an  escharotic  cannot  be 
stated  ^^"ith  positiveness.  The  several  views  advanced  merit  our  atten- 
tion, but  discussion  of  them  to  a  definite  conclusion  is  hardly  possible. 

Sollmann*  regards  paralysis  of  the  capillaries  as  the  beginning  of  its 
action,  ^^■hich,  with  increased  permeability  of  their  walls,  is  followed  by 
exudation  into  the  connective  tissue.  These  changes,  it  is  observed, 
are  very  similar  to  those  of  inflammation.  Fatty  degeneration  of  cells 
results  and  the  destruction  of  tissue  is  accomplished  without  evident 
chemical  reactions.  This  author  finds  support  to  the  theory  of  capil- 
lary paralysis  in  the  fact  that  intravenous  hijections  of  large  quantities 
of  salt  solution  will  cause  edema  in  animals  poisoned  with  arsenic,  but 
not  in  normal.  He  suggests  further  that  the  distention  of  capillaries 
may  lead  to  their  rupture  and  the  formation  of  ecchymoses.  (It  would 
seem  that  such  changes  must  take  place  in  the  walls  of  the  digestive 
tract  in  arsenical  poisoning,  for  the  symptoms  and  the  appearance  of 
the  discharges  are  almost  identical  with  those  of  cholera,  and  the 
destruction  of  tissue  found  after  death  is  regarded  as  due  to  degeneration 

*  SoUmaun's  Pharmacology,  1901. 


UNCLASSIFIED  ESCHAROTICS  85 

and  not  to  any  direct  action  of  the  poison.)  Regarding  changes  in  the 
blood  opinions  differ,  but  Silberman*  asserts  that  arsenic  tends  to  cause 
intravascular  coagulation,  and  the  experiments  of  Heinz  t  indicate  that 
this  is  not  ordinary  coagulation,  but  formation  of  thrombi  of  blood 
plates,  and  he  attributes  the  hemorrhages  to  such  thrombosis. 

A  theory  of  the  action  of  arsenic  advanced  by  Binz  and  Schultzi  is 
to  the  effect  that  arsenous  a(  id  is  oxidized  to  arsenic  acid  by  living 
tissue  and  the  arsenic  acid  is  again  reduced  to  arsenous.  This  alternate 
withdrawal  and  supply  of  oxygen,  in  its  influence  upon  the  protoplasm, 
is  supposed  by  them  to  be  the  essential  feature  of  the  action  of  arsenic. 

Arsenic  will  attack  any  soft  tissue  to  which  it  is  applied,  so  that, 
when  explaining  its  action,  we  must  recognize  its  influence  upon  the 
vitality  of  tissue  apart  from  kind  or  location;  but  within  the  pulp 
cavity  and  upon  so  vascular  and  highly  sensitive  an  organ,  enclosed 
as  it  is  by  bony  walls  with  very  small  unyielding  openings  for  vessels 
and  nerves,  the  factors  of  increased  pressure,  due  to  the  intense  hj'per- 
emia,  and  leading  to  stoppage  of  the  circulation  by  strangulation  of 
vessels  or  by  thrombosis,  is  believed  to  contribute  largely  to  the  destruc- 
tive action. 

The  occurrence  of  pain  in  connection  with  pulp  devitalization  depends 
somewhat  upon  the  condition  of  the  pulp.  A  healthy  pulp,  that  has 
not  become  irritated,  may  be  destroyed  without  any  pain;  but  in  the 
average  case  where  irritation  has  occurred,  it  must  be  expected  that 
within  a  varying  period  of  time  after  the  application,  usually  several 
hours,  the  patient  will  experience  pain,  first  gnawing,  later  throbbing 
in  character,  which  will  continue  until  the  pulp  is  destro}'ed,  which  is 
accomplished  in  from  six  to  forty-eight  hours,  as  a  rule. 

Combinations. — In  its  use  as  a  devitalizer,  arsenic  is  combined  with 
other  substances  to  meet  two  objects — to  obtain  a  convenient  form  for 
application  and  to  lessen  the  pain  of  its  action.  The  form  mostly  pre- 
ferred is  that  of  a  paste,  which  is  prepared  by  rubbing  up  the  powdered 
arsenic  with  a  sufficient  quantity  of  a  volatile  oil,  creosote,  glycerin  or 
carbolic  acid.  The  antiseptic  character  of  these  drugs  may  be  held  by 
some  to  give  added  value,  but  arsenic  itself  is  a  sufficient  antiseptic  as 
to  really  need  no  addition  on  that  score. §     It  should  be  noted  that  any 

*  Cushny's  Pharmacology,  tliird  edition,  p.  615. 

t  Ibid.  t  Ibid.,  p.  619. 

§  According  to  Koch's  experiments  (Brunton's  Pharmacology',  1885,  p.  98),  arsenic 
is  one-tenth  as  strong  as  bichloride  of  mercury  in  antiseptic  power.  Cushny  (Phar- 
macology, third  edition,  p.  619)  states  that  it  is  less  poisonous  to  fungi  than  to  higher 
forms  of  life,  and  that  it  seems  to  have  no  effect  upon  the  action  of  pepsin  and  similar 
ferments. 


86  ESCHAROTICS 

strong  coagulant,  such  as  carbolic  acid,  by  coagulating  the  surface  of 
the  pulp  where  the  application  is  made,  -vvill  tend  to  hinder  penetration 
of  the  arsenic,  on  which  account  it  is  inferior  to  a  volatile  oil.  Some- 
tunes  cotton  fiber  is  incorporated  with  the  paste,  and  being  then  dried, 
is  known  as  "devitalizing  fiber."* 

To  lessen  the  pain  of  de^'italization  a  number  of  drugs  have  been 
recommended  and  used,  but  the  list  can  now  be  narrowed  down  practi- 
cally to  one,  or  substitutes  for  it.  Cocaine  hydrochloride  possesses 
every  quality  that  is  essential,  with  no  serious  disadvantage.  It  is 
soluble,  it  mixes  with  the  substances  usually  combined  in  the  paste, 
and  it  is  more  efficient  than  any  other  known  agent.  The  danger  of 
absorption  into  the  general  circulation,  with  the  small  quantity  employed 
and  the  barrier  presented  to  its  penetration,  is  so  slight  that  it  may 
usually  be  disregarded.  Any  quantity  not  exceeding  one-quarter  of 
a  grain  may  be  regarded  as  safe  to  use.  Proper  substitutes  for  this 
drug  are  eucaine,  novocaine  and  orthoform,  any  one  of  which  may  be 
employed,  but  they  are  not  more  efficient  than  cocaine.  Their  chief 
advantage  is  in  being  less  toxic,  although  it  may  be  found  by  experi- 
ence with  orthoform  that  its  influence  is  more  prolonged  because  of  its 
insolubility. 

In  considering  this  part  of  the  subject  it  should  be  remembered  that 
pain  in  a  tooth  pulp  can  be  practically  relieved  at  two  points — either 
at  the  pulp,  by  agent;^  that  paralyze  the  terminals  of  the  sensory  nerve, 
or  at  the  centers  of  appreciation  of  painful  sensation  in  the  brain,  by 
agents  that  depress  or  benumb  those  centers.  Corresponding  in  their 
site  of  action  to  these  two  points,  we  have  two  classes  of  anodynes — 
those  that  act  locally  upon  the  periphery  of  nerves,  and  those  that  act 

*  The  following  formulas  of  arsenical  pastes  are  typical  and  useful: 

Gm. 

I^ — Arseni  trioxidi 2 1  (gr.  30). 

Novocaine I'SO  (gr.  22). 

Olei  carophylli  q.  s.,  to  make  a  paste. 
Coloring  matter  may  be  added,  if  desired  to  make  it  contrast  to  the  tooth  substance. 

Gm. 

I^ — Arseni  trioxidi, 

('ocaina3  hydrochloridi      .      .      .      .   aa     1 '  30  (gr.  22). 

Mentholis 'sO  (gr.     5). 

Glyc-erini  (}.  s.,  to  make  a  jiaste.  (Kirk). 

Gm. 

I^ — Arseni  trioxidi, 

(yocaina;  hydrochloridi      .      .      .      .   aa     1 1 30  (gr.  22) 

Olei  caryophylli  q.  s.,  to  make  a  paste.  (Miller). 


UNCLASSIFIED  ESCHAROTICS  87 

centrally  upon  the  centers  for  painful  sensation.  Agents  that  act  locally 
as  anodjaies  have  little  or  no  central  effect  in  ordinary  doses^  and,  con- 
versely, agents  that  relieve  pain  by  depressing  brain  centers  may  have 
no  effect  of  this  kind  when  applied  locally.  This  line  of  discussion  is 
prompted  by  the  fact  that  morphine  is  so  commonly  recommended  as 
a  local  anodyne  combined  with  arsenic.  This  is  entirely  opposed  to  our 
knowledge  of  the  action  of  morphine.  This  drug  has  almost  no  local 
action  when  applied  to  sensory  nerve  endings,  but  is  anodyne  only 
through  its  central  action,  after  being  absorbed  into  the  blood  in  suffi- 
cient quantity.  Morphine  locally  applied,  therefore,  can  be  of  little 
use  for  the  purpose  of  mitigating  the  pain  or  irritation  caused  by  arsenic. 
This  fact  was  recognized  many  years  ago*  and  is  fully  supported  by  the 
most  recent  authorities.!  The  volatile  oils,  thymol,  iodoform  and 
carbolic  acid  are  all  feebly  analgesic,  but  inferior  to  cocaine,  while  iodo- 
form has  the  disadvantage  of  disagreeable  odor,  and  carbolic  acid  is  a 
coagulant. 

Local  Poisoning  by  Arsenic. — The  lodgment  of  arsenic  between  the 
teeth  or  beneath  the  edge  of  the  gum  will  cause,  after  some  hours, 
local  irritation  leading  to  engorgement  of  the  gum,  which  will  be  fol- 
lowed by  sloughing  if  the  poisoning  is  severe.  Pain  may  be  absent. 
These  symptoms  will  correspond  in  extent  to  the  depth  of  penetration 
of  the  arsenic,  sometimes  including  pericementum  and  alveolus.  All 
tissues  whose  vitality  has  been  seriously  disturbed  must  be  expected  to 
slough  away. 

Treatment  of  this  condition  will  include  the  removal,  by  cutting 
or  scraping,  of  all  tissue  that  has  been  destroyed,  the  scarification  of 
engorged  tissue  to  secure  free  bleeding,  and  washing  away  of  any  parti- 
cles of  the  drug  that  may  remain  undissolved,  by  injecting  a  stream  of 
water  between  tooth  and  gum.  Following  this,  gentle  massage  of  the 
gums  of  the  whole  region  will  be  useful.     As  a  rule,  when  the  patient 


*  Harris's  Principles  and  Practice  of  Dentistry,  tenth  edition,  1876,  page  371. 
"Morphine  was  formerly  supposed  to  modify  the  irritating  action  of  arsenous  acid, 
but  since  this  has  been  discovered  not  to  be  the  case,  its  use  has  been  dispensed 
with  by  many." 

t  Cushny,  Pharmacology  and  Therapeutics,  1901,  page  208.  "It  is  often  stated 
that  the  sensory  terminations  are  paralyzed  by  morphine,  and  solutions  are  therefore 
injected  into  the  seat  of  pain,  or  hniments  are  rubbed  into  the  skin  over  it,  but  as  a 
matter  of  fact,  morphine  seems  entirely  devoid  of  any  such  local  action." 

SoUmann,  Pharmacology,  1901,  page  204.  "Particular  stress  must  be  laid  on  the 
fact  that  the  sensory  endings  are  in  no  way  affected,  so  that  the  local  application  of 
morphine  or  opium  is  entirely  iiTational." 


88  ESCHAROTICS 

presents  with  these  s\7nptoms  the  damage  will  have  been  done,  and 
local  medication  is  of  doubtful  value.  But  if  any  arsenic  still  remains 
about  the  tissues,  the  freshly  prepared  ferric  hydroxide  will  neutralize 
it  wherever  accessible.  The  latter  may  be  packed  about  the  teeth  and 
beneath  the  gum  margin.  Dialyzed  iron  has  been  recommended,  but 
it  is  inferior  to  fresh  ferric  hydroxide  (see  below).  Tincture  of  iodine  is 
beheved  by  some  to  be  a  useful  application,  and  the  same  may  be  said 
of  tincture  of  chloride  of  iron,  but  neither  of  these  exert  any  antidotal 
action  except  as  they  stimulate  the  tissues  to  better  resistance.  Scari- 
fication will  usually  precede  the  use  of  any  of  these  agents. 

General  Poisoning  by  Arsenic* — Acute  general  poisoning  occurs  as  the 
result  of  an  overdose  being  taken  into  the  stomach.  Usually  the  symp- 
toms develop  slowly,  beginning  with  gastrointestinal  irritation.  There 
is  in  most  cases  sufficient  tune  to  administer  an  antidote  and  empty 
the  stomach  if  the  mistake  of  dosage  is  discovered  at  once.  An  ordi- 
nary emetic  is  to  be  given  at  once  (one  to  three  teaspoonfuls  of  mustard 
flour  in  a  glass  of  lukewarm  or  cold  water,  or  the  same  quantity  of 
either  powdered  alimi  or  common  salt  with  a  little  water,  or  one-third 
of  a  teaspoonful  of  sulphate  of  zinc);  meantime  the  antidote  should 
be  prepared  and  given. 

The  best  antidote  to  arsenic  is  ferric  hydroxide,  which  is  prepared 
by  adding  an  alkali  to  a  solution  of  a  ferric  salt,  which  precipitates 
the  brown  ferric  hydroxide.  It  must  be  freshly  prepared.  This  is 
easily  done  by  mixing  7)iilk  of  magnesia  (Magma  Magnesiae,  U.S. P.) 
with  tincture  of  chloride  of  iron  or  with  MonseVs  solution,  both  agents 
to  be  diluted  somewhat  before  mixing.  It  should  be  taken  freely 
immediately  after  being  mixed,  as  it  gelatinizes  upon  standing.  The 
official  dose  is  f§4  (120  mils).  (See  also  Table  of  Poisons  and  Anti- 
dotes.) 

Cobalt  (not  official). — While  pure  cobalt  [Co]  is  a  distinct  chemical 
element,  in  the  commercial  form  arsenic  is  associated  with  it.  It  is 
employed  to  devitalize  pulps,  and  in  this  use  it  acts  very  much  like 
diluted  arsenic,  being  slower  in  action  and  less  irritating  than  pure 
arsenic,  and,  in  some  cases,  even  painless. 


*  The  fact  may  be  stated  that  in  some  parts  of  the  world,  especially  in  Styria,  the 
peasants  take  arsenic  habitually  and  acquire  a  tolerance  to  the  drug,  so  that  they 
take  quantities  which  would  ordinarily  be  poisonous.  It  is  claimed  that  it  secures 
a  ruddy  complexion  and  plumpness  of  form,  as  its  action  favors  the  deposit  of  fat 
in  the  tissues,  and  that  mountain  climbing  is  easier  under  its  use,  requiring  less 
effort  and  producing  less  respiratory  discomfort. 


UNCLASSIFIED  ESCHAROTICS  89 

Actual  Cautery. — This  term  applies  to  the  use  of  heat  of  sufficient 
degree  to  burn  the  tissue.  Formerly  an  iron  or  silver  wire  was  employed, 
heated  to  a  white  heat.  Pulps  were  destroyed  by  plunging  the  heated 
wire  directly  into  the  pulp  canal.  Fortimately  both  the  means  and  its 
use  have  become  obsolete.  Nevertheless  heated  metallic  points  and 
wire  loops  are  frequently  employed  in  general  and  special  surgery 
today.  The  approved  methods  of  applying  the  actual  cautery  are  the 
following : 

Thermocautery. — Under  this  term  there  is  arranged  an  apparatus,  by 
means  of  w^hich  a  platinum  point,  previously  heated  up  in  a  gas  or  spirit 
flame,  is  maintained  continuously  at  a  white  or  red  heat  by  the  com- 
bustion of  gasoline  vapor  forced  through  it.  Paquelin's  thermocautery 
is  the  one  mostly  used.  Platiniun  points  of  various  sizes  and  shapes 
permit  an  extensive  use  of  this  method  for  removal  of  small  tumors, 
checking  hemorrhage,  etc.  It  is  seldom  used  about  the  mouth,  prefer- 
ence being  given  to  the  galvanocautery. 

Galvanocautery. — This  consists  of  a  galvanic  battery,  arranged  in 
simple  circuit — i.  e.,  with  all  positive  elements  connected  together  and 
likewise  all  negative,  so  as  to  equal  in  effect  one  large  cell.  A  battery 
so  arranged  presents  a  large  surface  of  elements  with  the  resistance  of 
only  one  cell.  It  furnishes  a  large  quantity  of  electricity  capable  of 
producing  a  high  degree  of  heat  when  it  meets  with  external  resistance. 
Platinum  loops  in  various  shapes  and  sizes,  adapted  to  cutting,  searing 
or  snaring  tissue,  are  employed.  One  of  these  mounted  upon  a  suitable 
hand-piece  and  included  in  the  current  furnishes  a  sufficient  resistance 
to  convert  the  electricity  into  heat,  the  degree  of  which  can  be  easily 
regulated  by  mauipulation  of  the  battery. 

A  great  advantage  attaching  to  this  method,  for  use  about  the  face 
and  mouth,  is  that  the  patient  need  not  see  the  heated  loop.  It  may  be 
placed  right  in  proximity  to  the  diseased  or  bleeding  tissue  before  the 
current  is  turned  on;  and  if  the  application  of  cocaine  precedes  its  use 
the  pain  is  not  severe. 


CHAPTER   VIII. 
DEMULCENTS  AND  EMOLLIENTS. 

DEMULCENTS. 

Demulcents  are  agents  that  protect  or  soothe  raw,  irritated  or 
inflamed  surfaces.  They  consist  chiefly  of  oily,  mucilaginous  or  albumi- 
nous substances,  of  which  the  ones  here  named  are  the  most  important: 

Oleum  olivse  {olive  oil).  Acacia  {gum  arabic). 

Oleum  lini  {linseed  oil).  __      Limim  {flaxseed). 
Oleum  gossypii  seminis  {cottonseed  oil).  llmus  {slippery  elm  bark). 

Petrolatum  liquidum  (albolene).  Albumin. 

The  oils  are  used  in  their  ordinary  form,  as  a  rule;  sometimes,  how- 
ever, the  addition  of  an  alkali  is  ad\isable,  and  such  a  combination  is 
found  in  the  time-honored  'carron  oil,"  known  officially  as  linimen- 
tirai  calcis.*  This  has  long  been  a  favorite  application  to  burns  and 
scalds.  A  disadvantage  in  its  use  lies  in  the  fact  that  linseed  oil  dries 
upon  exposure,  and  the  stiffening  of  the  dressing  which  results  may 
make  it  more  difficult  to  remove.  This  may  be  obviated  by  substituting 
cottonseed  oil  for  linseed  oil  in  the  combination. 

In  poisoning  by  corrosives  and  irritants,  demulcents  are  valuable  to 
protect  the  injured  surfaces.  Any  of  the  above  are  applicable,  except 
that  in  poisoning  by  phosphorus  or  cantharides  oils  shoukl  not  be  used, 
as  they  are  solvents  for  these  drugs.  In  any  case  where  albumin  is  the 
proper  antidote  it  may  be  the  demulcent  of  choice  so  as  to  serve  a  double 
purpose,  raw  egg  being  the  best  form. 

The  mucilaginous  drugs  are  employed  in  aqueous  solution,  either 
infusion,  mucilage  or  syrup,  and  are  for  internal  use,  being  seldom 
applied  externally  except  in  poultices.  When  flaxseed  tea  is  to  be 
prepared,  the  whole  seed,  not  ground,  should  be  treated  with  hot  water. 
The  mucilage  is  present  in  the  shell  and  is  thus  easily  dissolved  out. 
The  ground  seed  is  used  only  in  poultices. 

Gm.  or  mil. 

*I^— Oleilini 60|  (fgij) 

Liquoris  calcis 60  (fBij) — M. 

Sig. — Apply  freely  and  cover  with  dressing. 


EMOLLIENTS  91 

Certain  sialagogues  and  expectorants  may  exert  a  secondary  demul- 
cent effect  through  stimulating  secretion  in  the  irritated  or  inflamed 
part.  Irritation  of  the  air  passages,  and  particularly  an  irritative 
cough,  is  often  due  to  dryness  of  the  mucous  membrane.  Sialagogues 
or  expectorants  may  be  the  very  best  agents  to  relieve  this  irritation  by 
increasing  secretion,  which  moistens  the  irritated  surface,  and  at  the 
same  time  the  engorgement  of  the  tissue  is  lessened.  The  drugs  mostly 
used  in  this  way  are: 

Cubeba  (cubeb  berries).  Ipecacuanha. 

Glycyrrhiza  {licorice  root).  Ammonii  chloridum. 

EMOLLIENTS. 

Emollients  are  agents  that  soften  and  soothe  an  inflamed  part.  Fatty 
preparations,  in  the  form  of  ointments,  are  used  to  soften  the  skin  and 
at  the  same  time  protect  denuded  or  ulcerated  surfaces  from  dust  and 
from  the  drying  effect  of  the  air.  Among  the  fats,  lanolin  (adeps  lanse), 
the  fat  of  sheep's  wool,  deserves  special  mention  as  a  valuable  emollient. 
Its  penetrating  and  softening  power,  it  is  claimed,  exceeds  that  possessed 
by  any  other  fat;  and  it  has  the  unique  property  of  mixing  with  at  least 
30  per  cent,  of  its  own  weight  of  water  without  losing  its  ointment-like 
character.  The  latter  quahty  permits  the  use  of  solutions  of  salts  or 
alkaloids  in  an  ointment,  which  is  often  desirable,  as  in  case  of  a  pain- 
ful sore.  Here  a  crj'stalline  substance  like  cocaine  should  be  more 
active  when  in  solution  and  mixed  with  lanolin,  than  when  the  particles 
are  simply  rubbed  up  with  a  fat  that  has  feeble  penetrating  power. 

Where  protection  by  a  fat  is  the  chief  purpose,  lard  (adeps)  and 
vaseline  (petrolatimi)  are  the  most  commonly  employed  bases  for  oint- 
ments, but  in  softening  and  penetrating  power  they  seem  to  be  inferior 
to  lanolin.  Lard,  being  an  animal  fat,  is  better  in  this  respect  than 
vaseline,  which  is  not  a  true  fat,  but  a  product  obtained  in  the  distilla- 
tion of  petroleum. 

The  poultice  (cataplasm)  is  another  form  of  emollient  application. 
Various  substances  may  enter  into  the  composition  of  poultices,  but  the 
possibilities  of  their  use  are  most  typically  combined  in  ground  flaxseed. 
The  shell  of  this  seed  contains  15  per  cent,  of  mucilage  and  the  interior 
contains  25  to  40  per  cent,  of  oil.  By  treating  the  ground  seeds  with 
hot  water  we  obtain  a  poultice  having  the  emollient  qualities  of  both 
oil  and  mucilage.  Applied  hot  the  relaxing  effect  of  the  heat  contributes 
to  the  softening  process,  and  altogether  we  have  in  the  poultice  a  great 
aid  in  either  resolving  an  inflammation,  or  hastening  suppuration  when 
it  cannot  be  prevented. 


92  DEMULCENTS  AND  EMOLLIENTS 

Glycerinum. — Glycerin. — Glycerol.  This  substance  is  obtained  by 
decomposition  of  oils  and  fats,  being  a  by-product  in  the  manufacture 
of  soaps,  and  it  should  contain  not  less  than  95  per  cent,  of  absolute 
glycerol  [C3H5(OH)3],  a  trihydric  alcohol. 

It  is  a  thick,  heavy,  colorless  liquid,  neutral,  freely  soluble  in  water, 
in  alcohol  and  in  a  mixture  of  1  part  ether  and  3  parts  alcohol,  but 
insoluble  in  ether,  chloroform  and  oils.  Its  specific  gravity  is  about 
1.250.  It  has  a  sweet  taste,  and  when  applied  to  a  mucous  surface 
produces  a  warm  or  burning  sensation.  It  does  not  coagulate  albumin. 
The  chief  quality  that  determines  its  action  upon  tissue  is  its  marked 
affinity  for  water,  it  being  capable  of  absorbing  50  per  cent,  of  its  own 
weight;  therefore,  when  applied  to  a  raw  surface  glycerin  may  irritate 
by  its  energetic  abstraction  of  water,  but  it  does  not  irritate  the  unbroken 
skin  or  mucous  membrane.  Its  eftect  upon  tissue  is  to  soften  and 
protect. 

As  an  emollient,  glycerin  is  used  extensively  in  hand  lotions  and 
either  in  full  strength  or  diluted  with  an  equal  quantity  of  water,  as  a 
simple  application  to  chapped  hands.  Here  its  action  is  typically  seen. 
The  smarting  at  first  experienced  is  due  to  its  abstraction  of  water 
from  the  tissues  wherever  the  skin  is  cracked  or  broken.  This  is  suc- 
ceeded by  a  softness  of  the  skin,  due  to  the  increased  amount  of  moisture 
which  is  attracted  into  the  superficial  layers  of  epithelium  by  the  action 
of  the  glycerin.  When  we  observe  that  chapping  of  the  hands  occurs 
mostly  in  cold  weather,  when  the  absolute  moisture  of  the  atmosphere 
is  greatly  reduced  by  precipitation,  we  can  appreciate  the  importance, 
as  a  causative  factor,  of  excessive  drying  of  the  skin  by  the  surrounding 
air;  and  we  are  helped  to  an  understanding  of  the  value  of  glycerin  as  a 
retainer  of  moisture  wherever  applied  to  soft  tissues.  The  maintenance 
of  a  normal  degree  of  moisture  is,  of  com-se,  essential  to  the  healing  of 
wounds  of  the  skin. 

Roughness  of  the  hands,  or  of  the  skin  of  other  parts,  is  effectually 
treated  by  a  lotion  of  glycerin  and  water,  or  glycerin,  water  and  alcohol. 
If  there  is  a  tendency  to  scaling  of  the  epithelium,  or  increase  of  seba- 
ceous secretion,  as  in  "dandruff"  of  the  scalp,  the  addition  of  salicylic 
acid  is  very  useful.     The  following  formula  is  suggested: 

Gtn.  or  mil. 


I^ — Acidi  salicylici 1 

Alcoholis 30 

Glycerini 30 

Olei  amygdalae  amarse 

Aquffi q.  s.  ad  90 

Sig. — Hand  lotion. 


(gr.  xv) 

(fSj) 

(f5j) 

30         (mv) 

ad  (f5iij).— M. 


EMOLLIENTS  93 

Glycerin  keeps  indefinitely  and  is  even  classed  among  the  antiseptics. 
It  is  an  excellent  preservative.  It  is  used  also  as  a  solvent  and  vehicle 
for  other  drugs,  and  is  often  incorporated  in  small  amount  with  extracts 
in  order  to  keep  them  from  becoming  dry. 

Its  combination  with  tannic  acid,  known  as  glycerite  of  tannic  acid,* 
is  a  powerful  astringent.  In  dentistry  it  is  used  in  case  of  hyperemia 
of  the  pulp  previous  to  capping;  also  after  the  application  of  arsenic  to 
a  pulp,  it  may  be  employed  to  harden  or  tan  the  pulp  tissue  in  order 
to  facilitate  its  removal.  It  is  a  generally  useful  astringent  to  mucous 
membranes. 

Incompatibility. — With  borax  a  solution  is  formed  which  becomes 
acid  in  reaction,  but  whose  value  is  not  otherwise  lessened.  Glycerin 
should  never  be  combined  with  nitric  and  sulphuric  acids,  nor  with 
chromic  acid,  chlorinated  lime  or  potassium  permanganate,  for  fear  of 
explosive  results. 

*  The  official  Glycerituni  acidi  tannici  has  the  following  formula : 

Gm.  or  C.c. 

I^ — Acidi  tannici * 201 

Glycerini 80 1 

M. — Heat  mixture  until  complete  solution  occurs. 


CHAPTER   IX. 
ASTRINGENTS  AND  HEMOSTATICS. 

Astringents  are  agents  that  cause  contraction  of  tissue.  In  a 
general  view  of  the  use  of  ajStringents,  we  include  the  checking  of  hem- 
orrhage and  of  diarrhea  and  the  lessening  of  inflammation,  particularly 
of  the  mucous  surfaces. 

The  several  modes  of  action  of  astringents  may  be  stated  to  be: 

1.  Simple  contraction  of  the  tissues  of  the  part,  as  by  cold  appli- 
cations. 

2.  Coagulation  of  the  surface,  as  by  tannic  acid. 

3.  Constriction  of  arterioles,  thus  lessening  the  blood  supi)l}^  to  the 
tissues,  as  by  application  of  suprarenal  gland  protlucts.* 

4.  Abstraction  of  water  from  the  tissues,  as  by  alcohol  locally  applied. 

The  terms  hemostatic  and  styptic  apply  to  agents  that  arrest  hemor- 
rhage. Most  of  these  act  by  securing  coagulation  of  the  blood,  but 
some  act  mechanically,  such  as  ligatures  and  bandages,  and  others 
lessen  the  blood  supply  to  the  bleeding  part,  as  cold  and  arterial  seda- 
tives. Other  styptics  induce  contraction  of  the  arterioles;  ergot, 
antipyrine,  suprarenal  gland  and  the  local  application  of  hot  water,  all 
act  in  this  way,  ergot  acting  through  the  system,  while  the  others  act 
by  local  application.  Collodion  exerts  pressure  through  contraction 
of  its  volume  while  drying. 

It  must  be  borne  in  mind  that  the  one  object  of  employing  any  hemo- 
static is  to  secure  coagulation  of  blood  at  the  point  of  hemorrhage;  and 
the  employment  of  the  various  agents  can  only  facilitate  this  process; 
so  that  the  use  of  coagulating  agents,  the  lessening  of  the  amount  of 
blood  in  the  part,  the  contraction  of  arterioles,  and  the  employment 
of  pressure,  all  have  precisely  the  same  object,  but  secure  it  in  different 
ways.  The  choice  of  agent  depends  upon  locality  and  size  of  the  vessels 
that  are  injured. 

A  capillary  hemorrhage  can  usually  be  controlled  by  coagulants,  or 
by  cold,  or  by  agents  like  antipyrine,  which  causes  the  arterioles  to 
contract.  If  the  hemorrhage  is  from  a  larger  vessel,  or  from  a  tooth 
socket,  where  the  muscular  control  of  the  capillary  circulation  is  dt^ficient, 
pressure  upon  the  bleeding  points,  or,  in  extreme  cases,  ligation  of  the 

*  The  U.  S.  Pharmacopoeia  gives  epinephrine  as  the  active  principle  of  the  .sujira- 
renal  glands.  This,  or  similar  body,  is  known  conunercially  as  adrenalin,  adnephrin 
and  suprarenin. 


ASTRINGENTS  AND  HEMOSTATICS  95 

vessel,  may  be  required.  Again,  in  case  of  hemorrhage  from  the  bowel 
or  lung,  perfect  rest  of  body  and  mind,  the  ice-water  coil  and  arterial 
sedatives  will  be  employed.  But  with  all  our  art  we  are  only  aiding 
nature  to  secure  coagulation. 

The  following  classification  will  aid  our  consideration  of  these  agents : 

Classification  of  Hemostatics. 

Coagulant  Astringents. 

1.  Vegetable. 

Tannic  acid. 

Drugs  containing  tannic  acid : 

Nutgall.  Hematoxylon. 

Gambir  (catechu).  Hamamelis. 

Kino.  Tea. 

Krameria.  Coffee. 

Alcohol. 

2.  Mineral. 

Iron  preparations : 

Tincture  of  ferric  chloride. 

Solution  of  ferric  chloride. 

Ferrous  sulphate. 

Ferric  subsulphas  (Monsel's  salt). 

Solution  of  ferric  subsulphate. 
Alum. 

Copper  sulphate. 
Lead  acetate. 
Silver  nitrate.* 
Zinc  chloride.* 
Zinc  sulphate. 
Vascular  Astringents. 

1.  Those  that  act  locally: 

Antipyrine. 

Epinephrine. 

Heat. 

2.  Those  that  act  after  absorption  into  the  general  circulation: 

Ergot. 
Gallic  acid. 
Remedies  that  Favor  Coagulation  of  the  Blood. 

1.  By  reducing  blood-pressure: 

Cold. 

Arterial  sedatives : 

Aconite. 

Veratrum  viride. 

2.  By  acting  in  the  blood  to  increase  its  coagulant  property: 

Calcium  salts. 
Thyroid  preparations. 
Blood  serum. 

3.  By  causing  direct  pressure  or  occlusion  of  vessels: 

Collodion. 

Bandages,  Hgatures  and  other  surgical  measures. 

*  Caustic  in  full  strength. 


96  ASTRINGENTS  AND  HEMOSTATICS 

Application  of  Cold. — By  this  is  meant  not  only  the  abstraction  of  heat, 
which  may  be  desirable,  but  also  the  contact  of  a  substance  having  a 
low  temperature  with  the  skin,  in  order  to  cause  a  reflex  contraction  of 
the  muscularis  of  the  skin  and  of  the  arterioles. 

The  ice-bag,  ice- water,  or  ice  directly  applied,  are  the  usual  means. 
If  considerablf  surface  is  to  be  treated,  a  very  convenient  method  of 
applying  ice-water  continuously  is  by  means  of  the  Leiter  coil,  which 
consists  of  soft-rubber  tubing  coiled  concentrically  to  fit  upon  the  part 
(as  in  form  of  skullcap  for  the  head),  or  wound  about  an  affected  joint; 
through  the  tubing  ice-water  is  run  by  siphonage  as  constantly  as 
may  be  desired.  Cold  applications  will  be  found  useful  to  lessen  the 
hyperemia  of  acute  inflammation  and  to  lessen  the  amount  of  blood  in 
the  locality  of  a  hemorrhage.  The  twofold  action  induced  is  reduction 
of  blood  supply  and  condensation  of  tissue.  In  employing  cold  locally 
to  relieve  toothache  we  secure  its  astringent  action  upon  the  local  cir- 
culation, and  we  also  have  the  sedative  effect  of  the  cold  upon  the 
nerve  endings.  A  pulpitis  may  sometimes  be  relieved  by  the  contact 
of  ice  with  the  tooth  and  contiguous  tissues. 

Application  of  Heat. — Practically  the  only  uses  of  heat  as  a  hemostatic 
are  two — (1)  as  hot  water  applied  to  a  surface  where  there  is  oozing 
from  small  vessels,  the  heat  causing  vascular  constriction  through 
irritation;  and  (2)  as  some  form  of  actual  cautery,  by  which  the  bleeding 
point  is  seared. 

Coagulant  Astringents  (Vegetable). 

Tannic  acid  is  the  astringent  principle  in  each  drug  of  the  vegetable 
group,  therefore  a  discussion  of  its  action  and  uses  will  suffice  for  all. 

Acidum  Tannicum. — Tannic  Acid. —  Tannin  [HC14H9O9]. — An  organic 
acid  obtained  usually  from  nutgall.  Average  dose  gr.  8  (0.5  gm.).  It 
is  a  yellowish  powder,  becoming  darker  upon  exposure;  soluble  in  less 
than  1  part  of  either  water  or  alcohol,  and  in  about  1  part  glycerin  with 
the  aid  of  moderate  heat.     These  solutions  have  an  acid  reaction. 

Its  chief  action  is  that  of  a  coagulant.  It  has  a  bitterish  and  astringent 
taste,  but  is  non-irritating  to  the  tissues.  It  is  useful  only  when 
applied  locally  to  tissues,  as  it  has  no  effect  through  the  circulation;  in 
fact,  tannic  acid  is  never  absorbed  into  the  circulation.  When  taken 
into  the  stomach  it  unites  with  any  albuminous  matter  present,  it 
interferes  with  the  activity  of  pepsin,  and,  if  in  excess,  some  may  be 
converted  into  gallic  acid,  which  can  be  taken  up  into  the  system. 


COAGULANT  ASTRINGENTS  97 

The  drug  may  be  applied  in  powder  to  a  bleeding-point,  or  packed 
with  cotton  into  a  tooth  socket.  In  any  strength  of  solution  it  may  be 
applied  to  inflamed,  raw  or  ulcerated  mucous  surfaces,  or  used  as  a 
gargle. 

In  catarrhal  and  relaxed  states  of  the  mucous  membrane  it  is  a  useful 
application,  especially  when  combined  with  glycerin.  Being  incom- 
patible with  alkaloids,  it  is  used  as  a  chemical  antidote  to  them.  In 
hemorrhage  from  the  stomach  it  is  taken  in  strong  solution  or  powder 
form,  but  for  internal  hemorrhages  outside  of  the  digestive  tract  it  is 
of  no  value,  except  as  it  is  changed  into  gallic  acid,  which  may  be 
absorbed  and  possibly  exert  some  general  influence. 

Tannic  Acid  Group  or  Vegetable  Astringents. — All  vegetable  astringents 
owe  their  activity  to  the  tannic  acid  which  they  contain,  so  it  is  a  matter 
of  personal  choice  whether  the  pure  acid  or  a  drug  containing  it  be 
used.  For  hemostatic  purposes  preparations  of  astringent  drugs  are 
rather  weak,  but  for  a  mouth  wash  or  gargle  they  are  useful. 

Incompatibility. — ^Tannic  acid  drugs  are  incompatible  with  albumin, 
alkaloids,  ferric  salts,  lime-water,  mineral  acids  and  most  metallic  salts. 

Galla. — XuTGALL. — ^An  excrescence  occurring  on  certain  species  of 
oak,  caused  by  the  puncture  and  deposit  of  ova  of  an  insect  This 
is  the  source  of  the  official  tannic  acid.  Average  dose  gr.  8  (0.5  gm.), 
but  the  drug  is  seldom  used  except  externally  in  the  form  of  tincture  or 
ointment. 

Gambir. — Catechu. — An  extract  prepared  from  leaves  and  twigs  of 
Ourouparia  gambir.     The  compound  tincture  and  troches  are  used. 

Kino. — The  dried  juice  of  Pterocarpus  marsupium,  average  dose  gr. 
8  (0.5  gm.).  The  tincture  is  the  only  official  preparation,  aA^erage  dose 
m  60  (4  mils). 

Krameria. — Rhat.ixy  (not  official). — The  root  of  several  species  of 
Krameria.     This  drug  has  a  number  of  preparations. 

Hematoxylon. — Logwood  (not  official). — The  heart-wood  of  Hcema- 
toxylon  campechianum.  Besides  tannin,  this  drug  contains  hematoxylin, 
which  is  used  to  stain  microscopic  specimens.  The  extract  may  be 
used. 

Hamamelis. — Witch-hazel  (not  official). — The  leaves  and  bark  of 
Hamamelis  virginiana  collected  in  autumn.     The  fluidextract  is  used. 

Tea  and  Coffee. — Although  not  official,  tea  leaves  and  coffee  seeds 
contain  a  variable  amount  of  tannic  acid,  tea  yielding  about  15  per 
cent,  and  coffee  somewhat  less. 

WTiile  all  tannins  are  similar,  some  may  be  distinguished  by  their 
7 


98  ASTRINGENTS  AND  HEMOSTATICS 

reaction  with  ferric  salts,  e.  g.,  gallotannic  acid  will  yield  a  bluish-black 
and  kinotannic  acid  a  greenish-black  ink. 

Drugs  of  this  group  are  non-poisonous.  Their  preparations  may  be 
used  freely  as  astringents  either  in  full  strength  or  diluted  with  water. 
[^  Alcohol. — Rectified  Spirit. — Ethyl  AIcoJwl  [C2H6OH].  A  liquid 
composed  of  about  95  per  cent,  by  volume  (92.3  per  cent,  by  weight) 
of  ethyl  alcohol  and  about  5  per  cent,  by  volume  (7.7  per  cent,  by 
weight)  of  water.  Sp.  gr.  about  0.816  at  60°  F.  It  is  obtained  by 
fermentation  of  grain  or  the  juices  of  fruits,  and  subsequent  distillation. 
It  is  a  clear,  colorless,  volatile  liquidji,  with  a  burning  taste  and  a  distinc- 
tive odor.    Alcohol  boils  at  172.4°  F. 

This  agent  is  nentraJ.  It  has  a  great  affinity  foi*  water,  even  absorb- 
ing it  from  the  atmosphere,  and  it  coagitlofes  albumin.  It  burns  with 
a  blue,  smokeless  flame,  yielding  a  high  degree  of  heat,  which  renders 
it  very  useful  in  the  spirit  lamp.  In  addition  it  is  extensively  used 
as  solvent,  preservative  and  drying  agent. 

The  following  strengths  of  alcohol  also  are  official,  but  whisky  and 
brandy  (about  50  per  cent.)  and  wines  (8  to  20  per  cent.)  have  been 
dismissed  from  the  Phormacojjoeia. 

Alcohol  Dehydratum  (not  less  than  99  per  cent,  by  weight)  is  the 
purest  spirit  obtainable.  Owing  to  the  strong  affinity  which  alcohol 
has  for  water,  it  is  impossible  to  separate  them  absolutely;  but,  by 
treating  strong  alcohol  with  potassium  carbonate  and  fused  calcium 
chloride,  w^hich  have  a  stronger  affinity  for  water,  and  redistilling,  all 
except  a  fraction  of  1  per  cent,  of  water  can  be  remo^'ed.  Absolute 
alcohol  is  equally  difficult  to  keep  in  full  strength  on  account  of  absorp- 
tion of  moisture  from  the  air.  It  must  be  kept  in  well-stoppered  bottles 
and  exposure  to  air  avoided.  It  is  highly  inflammable.  It  is  seldom 
that  so  strong  a  spirit  is  needed,  but  it  may  be  required  for  special  uses 
as  a  sohent  and  as  a  chemical. 

Alcohol  Dilutum  (about  49  per  cent,  by  volume).  This,  composed 
approximately  of  equal  parts  of  alcohol  and  water,  corresponds  nearly 
to  "proof  spirit"  (50  per  cent.),  which  is  the  United  States  standard 
for  measuring  unrectified  spirit. 

Spiritus  Frumenti  (whisky)  contains  from  44  to  55  per  cent,  b}'  vol- 
ume of  alcohol.  It  is  distilled  from  fermented  grain  and  should  be 
at  least  four  years  old.     (Not  official.) 

Spiritus  Vini  Gallici  (brandy)  contains  from  46  to  55  per  cent,  by 
volume  of  alcohol.  It  is  distilled  from  the  fermented  juice  of  grapes 
and  should  be  at  least  four  years  old.     (Not  official.) 


COAGULANT  ASTRINGENTS  99 

Whisky  and  brandy  do  not  gain  in  alcoholic  strength  by  age,  but 
they  develop  flavor;  and,  in  whisky  particularly,  the  fusel  oil,  which 
is  a  natural  impurity  of  raw  spirit,  is  destroyed  during  the  ripening  process. 

Local  Action  and  Uses  of  Alcohol. — ^This  drug  is  astringent  by  virtue 
of  its  power  to  coagulate  albumin  and  to  abstract  water  from  the  tissues. 
The  coagulum  is  not  so  firm  as  that  produced  by  most  mineral  astrin- 
gents, and  it  may  be  gradually  redissolved  by  the  alkaline  fluids  of  the 
tissues.  When  applied  in  the  full  strength  to  the  mucous  membrane, 
alcohol  induces  first  a  burning  sensation,  which  becomes  painful  as  the 
fuH  action  upon  the  tissue  is  attained.  With  its  evaporation  a  cooling 
sensation  may  then  be  experienced.  The  irritation  soon  passes  away, 
and  there  remains  a  sense  of  fulness  in  the  part,  with  corrugation  of 
the  surface,  which  at  the  same  time  has  acquired  a  whitish  appearance 
in  the  superficial  layer.  GraduaUy  the  mucous  membrane  will  be 
restored  to  its  normal  condition  with  very  slight  surface  exfoliation. 
The  action  is  very  superficial  and  of  only  moderate  duration.  Alcohol, 
therefore,  cannot  rank  as  more  than  a  mild  astringent,  but  the  posses- 
sion of  the  power  to  abstract  water,  with  its  volatility,  makes  it  a 
valuable  drying  agent  wherever  applied.  Added  its  antiseptic  quality, 
we  have  in  alcohol  an  agent  that  is  cooling  to  an  inflamed  surface, 
slightly  astringent  and  antiseptic — the  very  qualities  that  make  it 
(whether  used  pure,  diluted,  or  as  a  vehicle  for  other  substances)  a 
very  useful  wash  or  application  in  stomatitis  or  any  unhealthy  state 
of  the  gum  or  mucous  membrane.  The  strength  as  a  mouth  wash 
should  not  exceed  1  part  alcohol  to  2  parts  water. 

It  is  also  useful  as  a  drying  agent  in  cavities  and  root  canals;  and 
if  its  application  be  followed  by  that  of  chloroform  or  ether  a  mos 
perfect  and  rapid  removal  of  moisture  will  be  effected;  the  alcohol 
first  taking  up  the  moisture,  evaporation  is  then  hastened  by  the  alcohol 
being  taken  up  by  the  more  rapidly  volatile  chloroform  or  ether.  The 
only  precaution  necessary  regarding  this  use  is  the  avoidance  of  the 
proximity  of  a  flame,  because  of  the  inflammability  of  alcohol  and 
of  ether. 

Alcohol  is  also  a  useful  lotion  when  applied,  somewhat  diluted,  to  a 
bruised  or  inflamed  surface;  and  if  capillary  oozing  be  present,  its  action 
will  faA'or  coagulation  of  blood  and  contraction  of  arterioles. 

It  must  be  said  that  alcohol  contributes  much  to  the  local  action  of 
certain  tinctures,  of  which  tinctm-e  of  myrrh  is  an  example;  indeed,  in 
this  preparation  the  alcohol  is  much  more  important  and  active  than 
is  the  myrrh.     (See  under  Antiseptics.) 


100  ASTRINGENTS  AND  HEMOSTATICS 

Applied  to  the  skin,  the  action  of  alcohol  is  less  marked  than  upon 
mucous  membranes,  because  of  the  firmer  texture  of  the  former  and 
the  better  protection  it  affords  to  the  sensitive  structures  beneath. 
Rubbing  or  bathing  the  skin  with  alcohol  produces,  first,  cooling  of 
the  surface,  Avhich  is  soon  followed  by  a  reaction  that  is  delightful. 

The  power  of  attracting  moisture  gives  alcohol  a  place  as  a  remedy 
in  carbolic  acid  poisoning.  Its  action  here  is  more  upon  the  injured 
tissue  than  upon  the  poison.  (See  Phenol  Poisoning.)  The  same 
property,  plus  antiseptic  power,  makes  alcohol  a  detergent  of  some 
value. 

In  addition  to  remedial  uses,  alcohol  is  employed  largely  as  a  solvent 
for  drugs,  being  the  chief  menstruinn  in  fluidextracts,  thictures,  spirits 
and  elixirs,  besides  being  used  to  extract  many  vegetable  active  prin- 
ciples. When  selecting  an  astringent  drug  for  use,  it  follows  that  the 
thwture  of  that  dk-ug  (if  its  solution  in  alcohol  is  possible)  will  be  espe- 
cially efficient  by  reason  of  the  added  action  of  alcohol. 

Alcohol  is  also  used  as  the  general  solvent  for  resins,  as  in  the  prepa- 
ration of  sandarach  varnish. 

The  internal  action  of  alcohol  is  considered  under  Stimulants. 

Iruvmimtibility. — Alcohol  is  incompatible  with  albuminous  substances, 
all  of  which  are  coagulated  by  strong  alcohol.  It  precipitates  gums 
from  their  aqueous  solutions.  On  account  of  their  insolubility  in 
alcohol  many  salts  of  the  alkalies  and  metals  ma}'  be  precipitated  by  it 
from  their  aqueous  solutions.  Both  chromic  acid  and  potassium  per- 
manganate are  decomposed  by  alcohol. 

Methyl  Alcohol  (not  official). — Wood  Spirit  [CH4O].  A  thin  color- 
less liquid  obtained  in  the  destructive  distillation  of  wood.  It  has  a 
peculiar  odor  and  burning  taste,  sp.  gr.  about  0.800,  and  boils  at  about 
151°  F.  It  burns  with  a  pale,  smokeless  flame,  giving  less  heat  than 
ethyl  alcohol.  By  partial  oxidation  it  yields  formaldehyde  gas.  A 
purified  product  is  called  Columbian  Spirit.  Wood  spirit  is  used  as  a 
substitute  for  ethyl  alcohol  as  solvent  and  for  external  uses.  Its  use 
as  a  solvent  may  be  proper,  but  on  account  of  its  poisonous  action  it 
should  never  be  used  in  medicine.  Aside  from  deaths  caused  by  methyl 
alcohol,  many  cases  ha\'e  been  rej)orted  within  recent  years  where 
blindness,  more  or  less  ])ermanent,  followed  contact  with  the  fumes  of 
this  drug. 

Coagulant  Astringents  (Mineral). 

This  grouj)  of  drugs  stands  in  contrast  with  the  tannic  acid  group, 
as  we  might  expect  from  their  compound  chemical  nature.     They  are 


COAGULANT  ASTRINGENTS  101 

compounds  of  acids  with  metallic  bases,  so  that,  by  their  dissociation 
in  contact  with  tissues,  we  have  two  distinct  agents  concerned  in  the 
action  of  each  mineral  astringent.  This  fact  is  given  prominence  by 
some  of  the  later  authorities  in  pharmacology*  and  its  recognition 
removes  much  of  the  difficulty  in  understanding  the  action  of  these 
salts  upon  living  tissues.  The  essentials  of  their  action  may  be  stated 
as  follows:  Mineral  astringents  have  the  property  of  precipitating 
albuminous  or  proteid  substances.  ■  This  must  be  understood  to  be  a 
definite  chemical  reaction,  whereby  a  metallic  albuminate  is  formed 
and  the  acid  of  the  salt  is  liberated.  There  is,  therefore,  added  to  the 
coagulation  or  precipitation  process  the  action  of  whatever  acid  is 
liberated.  As  they  differ  in  coagulant  power,  the  sum  of  the  action 
of  such  astringent  will  depend,  as  Cushny  states,!  upon  "Two  factors — 
the  character  of  the  precipitate  and  activity  of  the  acid  formed.  The 
latter  again  varying  with  the  extent  to  wdiich  it  is  dissociated  into 
ions;  it,  therefore,  exercises  the  same  astringent  or  corrosive  efi'ects  as 
if  it  had  been  applied  uncombined.  But  its  action  may  be  modified 
by  the  presence  of  metallic  albuminate  protecting  the  surface."  The 
firmer  the  coagulum  the  less  will  the  liberated  acid  irritate  the  tissues, 
and,  on  the  other  hand,  the  stronger  the  acid  liberated  the  greater 
will  be  the  possibility  of  irritation  by  it.  We  would,  therefore,  expect 
the  mineral  acid  salts  to  be  more  irritating  than  organic  acid  salts. 
This  we  find  to  be  the  case  in  comparing  the  action  of  chloride  of  zinc 
with  that  of  acetate  of  lead.  Again,  among  the  mineral  acid  salts  those 
that  are  most  easily  dissociated,  such  as  the  soluble  chlorides  and 
nitrates,  are  found  to  be  most  irritating.  A  comparison  of  the  chloride 
and  sulphate  of  zinc  gives  evidence  of  this,  the  chloride  being  much 
more  irritating.  The  variety  of  these  mineral  compounds  permits  of 
the  selection  of  an  agent  for  any  grade  of  action  desired. 

The  group  of  astringent  iron  salts  in  common  use  comprise  the 
following,  all  of  which  are  acid  in  reaction: 

Ferri  Chloridum. — Ferric  Chloride  [FeCls  +  6H2O].  An  orange- 
yellow,  crystalline  salt,  with  a  strongly  astringent  taste.  Very  deli- 
quescent in  moist  air  and  freely  soluble  in  water  and  in  alcohol.  It 
contains  not  less  than  20  per  cent,  of  iron.  Used  chiefly  in  the  two 
following  preparations: 

Tinctura  Ferri.  Chloridi.— Tincture  of  Ferric  Chloride. — This  con- 
tains about  5  per  cent,  of  metallic  iron.  Average  dose,  TTL  8  (0.5  mil.). 
It  has  a  very  astringent  taste  and  acid  reaction. 

*  See  Cushny,  Pharmacology  and  Therapeutics,  fifth  edition,  628.    f  Ibid.,  p.  628. 


102  ASTRINGENTS  AND  HEMOSTATICS 

Liquor  Ferri  Chloridi. — Solution  of  Ferric  Chloride. — This  con- 
tains about  10  per  cent,  of  metallic  iron.  Average  dose,Tn,  1§  (0.1  mil.). 
It  has  a  very  astringent  taste  and  acid  reaction. 

Ferri  Subsulphas  (not  official). — Basic  Ferric  Sulphate. — MonseVs 
Salt. — The  chemical  composition  of  this  salt  is  variable. 

Liquor  Ferri  Subsulphatis. — Solution  of  Basic  Ferric  Sulphate. 
MonseVs  Solution. — This  contains  13.5  per  cent,  of  metallic  iron. 

This  preparation  is  often  improperly  called  persulphate  of  iron.  The 
true  persulphate  is  a  normal  salt,  official  in  form  of  its  solution  {Liquor 
Ferri  TersuJphatis)  but  very  seldom  used. 

Of  all  of  the  above,  the  liquor  ferri  subsulphatis  or  Monsel's  solution 
is  used  more  than  all  others  as  a  hemostatic.  It  is  objectionable  on 
account  of  the  copious,  dirty,  black  coagulum  which  it  produces;  and 
it  also  stains  any  fabric  that  it  touches.  It  is  not  an  agent  of  first 
choice,  but  is  used  rather  as  a  later  resort  when  the  milder  astringents 
have  failed.  It  is  very  efficient  even  when  largely  diluted.  As  astrin- 
gents for  use  in  the  mouth,  the  whole  group  here  named  are  objec- 
tionable because  of  their  strongly  acid  reaction,  which  renders  them 
deleterious  to  the  teeth.  If  employed  at  all,  strict  precaution  should 
be  taken  to  prevent  their  contact  with  the  teeth,  and  neutralization 
of  their  acidity  should  follow  their  use.  A  solution  of  sodium  bicar- 
bonate is  a  useful  alkali  for  the  latter  purpose.  Hemostatic  cotton  is 
prepared  by  satiu'ating  absorbent  cotton  with  either  Monsel's  solution 
or  solution  of  ferric  chloride  and  drying. 

It  should  be  remembered  that  not  all  iron  preparations  affect  the 
teeth.  They  all  may  form  iron  sulphide  in  a  foul  mouth  or  in  a  carious 
cavity,  with  a  resulting  stain,  but  only  those  that  have  an  acid  reaction 
are  destructive  to  the  tooth  structure.  All  astringent  iron  salts  are 
acid,  but  for  internal  administration  there  are  a  number  of  neutral 
preparations  that  are  harmless.     (See  under  Restorative  Tonics.) 

Incompatibility. — Ferric  salts  in  solution,  with  alkalies  or  alkaline 
carbonates  in  excess,  produce  a  brown  precipitate  of  ferric  hydrate. 
With  tannic  acid,  tannate  of  iron  (black  ink)  is  formed. 

Verroas  salts  with  oxidizing  agents  are  con\'erted  into  ferric  salts. 
With  alkalies  and  alkaline  carbonates,  solutions  of  ferrous  salts  yield 
precipitates.  Tannic  acid  produces  no  change  in  ferrous  salts  in  the 
absence  of  oxygen. 

Alumen. — ^Alum. — Aluminium  and  Potassium  Sulphate  [A1K(S04)2  + 
I2H2O],  or  Alumirmim  and  Ammonium  Sulphate  [A1NH4(S04)2  +  I2H2O]. 
Either  potassium  alum  or  ammoniiun  alum  is  official  under  this  title. 


COAGULAXT  ASTRIXGEXTS  103 

It  occurs  ixL  colorless  crystals  having  a  s\veetish  and  strongly  astringent 
taste  and  acid  reaction.  Potassium  alum  is  soluble  in  7.2  parts  of  cold 
water,  0.3  part  of  boiling  water,  freely  soluble  in  glycerin,  but  insol- 
uble in  alcohol.  Ammonia  alum  is  somewhat  less  soluble  in  water. 
Alum  coagulates  albumin,  acting  superficially  as  an  astringent  and 
hemostatic.  Average  dose,  gr.  8  (0.5  gm.).  In  larger  dose  the  drug 
is  emetic.  To  check  slight  hemorrhages  the  pure  crystal  or  strong 
solution  may  be  applied.  For  nosebleed  a  nasal  irrigation  or  injection 
of  the  solution  as  hot  as  can  be  borne  is  useful.  The  aqueous  solution 
may  be  used  in  any  strength  as  a  gargle  or  wash,  but,  being  acid  in 
reaction,  it  is  not  admissible  as  a  mouth  wash  for  continuous  use. 

AYhen  alum  is  subjected  to  a  high  degree  of  heat  it  loses  its  water  of 
crystallization  and  becomes  opaque  and  amorphous.  It  is  then  known 
as  dried  alum  (aliunen  exsiccatumj  or  ''biunt"  alum,  and  is  more 
energetic  in  its  action  upon  tissue,  being  even  escharotic  to  loosely 
organized  tissue. 

Incompatihility. — Alumen  is  incompatible  with  alkalies  and  their 
carbonates.  With  metals  soluble  m  dilute  sulphuric  acid  the  aqueous 
solution  of  alum  will  liberate  hydi'ogen. 

Argenti  Nitras. — Xitrate  of  Silat^r  [AgXOs].  AA-erage  dose,  gr.  | 
(0.01  gm.).  This  drug  is  described  and  discussed  qtiite  fully  in  the 
chapter  upon  Escharotics.  As  an  astringent  it  is  used  upon  mucous 
membranes  in  conditions  of  relaxation  or  of  clironic  catarrh,  such  as 
chronic  pharyngitis,  where  the  dilated  capillaries  give  evidence  of  a 
decided  loss  of  tone  in  the  mucous  membrane.  The  indications  here 
are  for  a  drug  that  will  cause  condensation  of  the  relaxed  tissue  ^dth 
contraction  of  the  dilated  vessels.  Xitrate  of  silver  is  one  of  our  best 
agents  to  accomplish  this  when  applied  in  solution  of  from  1  to  5  per 
cent.,  the  stronger  solutions  being  commonly  used  with  an  atomizer. 
It  is  irritatmg,  but  superficial  m  its  action.  It  coagulates  albumin. 
Its  irritant  action  is  explamed  m  part  by  the  liberation  of  nitric  acid 
at  the  time  of  its  coagulant  action,  albumin  taking  the  place  of  the  acid 
in  the  combination.  In  connection  with  the  application  of  this  drug 
it  may  be  remarked  that  a  catarrhal  condition  does  not  need  a  constant 
irritant.  The  restoration  of  the  ^-ascular  tone  will  occiu*  slowly  under 
the  influence  of  a  decided  local  stimulant  applied  not  too  frequently. 
For  the  best  effect,  therefore,  nitrate  of  silver  should  not  be  applied 
oftener  than  once  a  day  or  once  in  two  days.  In  general,  any  strength 
of  solution  may  be  used  up  to  5  per  cent.,  although  this  strength  is 
decidedly    irritating.     Any    excessive    action    may    be    prevented    by 


104  ASTRINGENTS  AND  HEMOSTATICS 

promptly  neutralizing  with  a  solution  of  sodium  chloride.  This  drug 
cannot  be  used  in  a  mouth  wash  nor  upon  visible  surfaces,  because  it 
blackens  tissues  and  fabrics  wherever  it  touches  and  may  stain  tooth 
structure.  The  solutions  of  siher  nitrate  are  neutral.  As  a  rule  it  is 
not  prescribed  in  combination  with  other  substances. 

Cupri  Sulphas. — Sulphate  of  Copper. — Blue  Vitriol  [CUSO4  +  5H2O]. 
This  substance  occurs  in  blue  crystals  with  a  metallic,  nauseous  taste, 
soluble  in  2.5  parts  of  water,  2.8  parts  of  glycerin  and  in  500  parts  of 
alcohol.  The  solution  is  acid  in  reaction.  It  coagulates  albumin.  It 
ranks  with  silver  nitrate  as  an  irritating  astringent,  being  even  a  mild 
caustic  when  used  in  the  form  of  crystal  or  strong  solution.  The  acid 
liberated  in  connection  with  its  coagulant  action  is  suljjhuric,  one  of 
the  most  irritating  of  acids.  Its  value  in  dental  practice  is  limited, 
being  useful  for  limited  application  where  a  decided,  though  irritating, 
astringent  efi'ect  is  desired.  If  it  is  allowed  to  enter  a  carious  tooth 
staining  is  likely  to  result. 

Internally  the  drug  is  emetic  in  ftill  dose,  the  average  dose  being  gr.  4 
(0.25  gm.).  In  case  of  poisoning  by  it  albumin  is  the  best  chemical 
antidote. 

Plumbi  Acetas. — ^Acetate  of  Lead. — Sugar  of  Lead  [Pb(C2H302)2 
+  3H2O].  Average  dose,  gr.  1  (0.06  gm.).  (For  preparations,  see 
Index  of  Drugs.) 

It  occurs  in  colorless  or  whitish  crj'stals  or  masses,  having  a  slight 
odor  and  sweetish,  astringent  taste.  It  is  somewhat  efflorescent, 
absorbing  carbon  dioxide  from  the  air;  soluble  in  1.4  parts  of  water 
and  in  38  parts  of  alcohol,  freely  in  glycerin.  It  is  slighth/  alkcdine  in 
reaction.  It  coagulates  albumin,  being  one  of  the  active  mineral  astrin- 
gents. It  is  classed  as  a  sedative  astringent  because  of  the  absence  of 
any  marked  irritation  from  its  application.  This  fact  agrees  with  the 
explanation  that  the  acid  of  an  astringent  salt  is  liberated  at  the  time 
of  the  coagulant  action,  being  displaced  by  the  albumin.  In  case  of 
this  substance  acetic  acid  is  liberated,  which  in  its  dilute  form  is  not 
irritating.  When  used  internally  this  drug  presents  the  danger  of  lead 
poisoning.  Therefore,  its  use  is  somewhat  restricted  as  to  quantity  and 
length  of  time  employed.  In  conditions  of  denuded  surfaces,  irritable 
ulcers,  and  acute  local  hiflammations  of  the  gums,  the  solution  may 
be  employed,  but  swallowing  the  drug  must  be  avoided.  On  account 
of  this  danger  the  lead  preparations  are  seldom  used  internally,  and 
even  their  external  application  to  large  surfaces  may  induce  poisoning. 
For  local  use  a  simple  solution  of  the  salt  in  water  or  alcohol,  or  the 


COAGULANT  ASTRINGENTS  105 

official  solutions  of  the  subacetate  may  be  employed.  The  latter 
contain  a  considerable  amount  of  oxide  of  lead,  which  is  soluble  in  a 
solution  of  the  acetate  with  a  change  of  the  latter  to  the  subacetate. 
The  official  diluted  solution,  known  as  lead^water,  is  of  proper  strength 
for  ordinary  use;  or  a  stronger  application  may  be  obtained  by  diluting 
the  stronger  solution,  which  is  known  as  Goulard's  extract.  A  favorite 
application  with  some  is  the  lead  and  opium  wash*  but  the  addition  of 
the  tincture  of  opium  can  contribute  very  little  to  the  local  action  of 
the  combination,  except  the  astringent  action  of  the  alcohol  it  contains, 
as  it  is  well  known  that  opium  has  no  appreciable  local  action. 

Among  the  evidences  of  saturation  of  the  system  by  lead,  there  is 
noticed,  especially  in  foul  mouths,  a  blue  line  within  the  gum  close  to 
the  margin.  This  is  believed  to  be  a  deposit  of  lead  sulphide  within 
the  tissue,  and  it  is  indicative  of  chronic  lead  poisoning  only.  (For 
symptoms,  etc.,  of  acute  poisoning,  see  Table  of  Poisons  and  Antidotes.) 

Incompatibility. — Acetate  of  lead  is  incompatible  with  most  acids 
which  displace  the  acetic  acid,  with  iodide  of  potassium  and  with  liquor 
iodi  compositus.  The  solution  of  the  subacetate  will  precipitate  solu- 
tions of  acacia. 

Zinci  Chloridum. — Chloride  of  Zinc  [ZnCl2].  This  substance  is 
used  more  as  an  escharotic  and  antiseptic,  but  in  the  weaker  solutions 
(1  to  10  per  cent.)  it  is  astringent.  It  coagulates  albumin,  but  on 
account  of  the  hydrochloric  acid  liberated  the  application  of  a  strong 
solution  is  painful,  and  it  is  also  quite  penetrating.     It  is  acid  in  reaction. 

Zinci  Sulphas. — Sulphate  of  Zinc. — White  Vitriol  [ZnS04  +  7H2O]. 
Average  dose,  as  emetic,  gr.  15  (1  gm.).  It  occurs  in  colorless  crystals 
or  crystalline  powder,  having  an  astringent,  metallic  taste,  soluble  in 
0.6  part  of  water  and  in  2.5  parts  of  glycerin;  insoluble  in  alcohol.  It 
is  acid  in  reaction  and  it  coagulates  albumin.  It  is  one  of  the  feebler 
astringents,  well  adapted  to  the  more  sensitive  mucous  membranes,  as 
the  conjunctiva  of  the  eye.  In  acute  conjunctivitis  and  in  acute 
disease  of  the  antrum,  it  is  a  useful  astringent  in  1  per  cent,  solution. 
About  the  mouth  it  may  be  used  stronger,  as  it  is  not  irritating  to  the 
oral  mucous  membrane.  It  is  a  reliable  emetic  frequently  employed 
to  empty  the  stomach  in  cases  of  poisoning.  In  such  emergency  a 
dose  of  30  grains  (2  gm.)  may  be  given. 

*  Lotio  plumbi  et  opii  (N.  F.): 

Gm.  or  mil. 

I^ — Plumbi  acetatis 17 1  5 

Tincturae  opii 35 

Aquse q.  s.  ad         1000 !       — M. 


106  ASTRINGENTS  AND  HEMOSTATICS 

IncomjxiiihUiiy. — vSiilphate  of  zinc  is  incompatible  witli  aUcalies'  and 
their  carbonates  and  with  ammonium  sulphide. 

Zinci  lodidum. — Iodide  of  Zinc  [Znl2]  (not  official). — This  salt  occurs 
as  a  white  powder,  having  a  sharp  taste,  very  deliquescent,  and  becom- 
ing brown  upon  exposure  frorri  the  liberation  of  iodine.  It  is  freely 
soluble  in  water  and  alcohol,  and  is  acid  in  reaction.  Its  action  is 
chiefly  alterative  combined  with  the  characteristic  action  of  the  zinc 
ion.  Dr.  E.  S.  Talbot,  after  considerable  experience  with  it,  advises 
its  use  in  interstitial  gingivitis  in  the  following  combination  with  iodine, 
to  which  he  gives  the  names  of  lodo-glycerole : 

Cim.  or  mil. 

I^ — Zinci  iodidi 15  j  (3iv) 

Aquse 10 1  (fSijss) 

lodi 25J  (3vj) 

Glycerini 50  i  (fSxijss) — M. 

Sig. — Apply  to  gums  every  second  day. 

His  purpose  in  using  the  zinc  iodide  is  to  increase  the  strength  of  the 
preparation  and  to  make  it  more  astringent. 

Zinci  Oxidum.^ — Zinc  Oxide  [ZnO].  A  very  fine  white  or  yellowish- 
w^hite  powder,  without  any  gritty  quality.  It  is  odorless,  tasteless  and 
insoluble  in  water  or  alcohol.  It  is  a  feeble  astringent,  very  mild  and 
even  soothing  in  effect,  so  that  it  may  be  applied  to  any  irritated  or 
denuded  surface.  Either  in  simple  powder  or  in  the  official  20  per  cent. 
ointment  it  is  largely  used  in  diseases  of  the  skin.  It  is  not  used 
internally. 

Vascular  Astringents. 

An  important  group  of  hemostatics  comprises  those  whose  chief  action 
is  upon  the  bloodvessels.  The  term  styptic  is  often  used  to  designate 
these.  Either  by  local  action  when  directly  applied,  or  by  stimulating 
the  vasomotor  nerve  supply,  they  induce  contraction  of  the  mus- 
cular coat  of  the  smaller  arterial  vessels,  thus  favoring  coagulation  by 
lessening  the  capillary  circulation.  They  do  not  coagulate  albumin. 
They  are  applicable  only  in  hemorrhages  of  the  smallest  vessels,  and 
particularly  those  in  which  unstriped  muscle  tissue  is  sufficiently 
abundant  to  be  a  factor  in  controlling  the  blood  supply;  for  these 
agents  act  only  through  direct  or  indirect  stimulation  of  the  layer  of 
unstriped  muscle  in  the  wall  of  the  vessel.  Where  this  is  deficient,  as 
in  bone,  they  are  likely  to  be  inferior  to  coagulant  agents.  Those  that 
act  locally  are  of  greatest  importance  to  the  dental  practitioner  and  will 
accordingly  be  first  considered. 


VASCULAR  ASTRINGENTS  107 

Antipyrina. — Phenazone  [C11H12OX2].  Average  dose,  gr.  5  (0.3  gm.). 
This  substance  is  obtained,  by  a  series  of  chemical  reactions,  from 
pyrrol,  a  base  found  in  coal-tar.  Chemically  it  is  phenyldimethyl- 
pyrazolon,  which  term  shows  the  impracticability  of  using  the  chemical 
names  of  many  of  the  newer  drugs.  Classed  generally  as  an  antipyretic 
and  analgesic  it  was  among  the  first  of  the  coal-tar  derivatives  intro- 
duced to  medicine.  It  occurs  in  colorless  crystals,  having  a  bitter  taste, 
neutral,  soluble  in  less  than  1  part  of  water  and  in  1.3  parts  of  alcohol, 
also  soluble  in  1  part  of  chloroform  and  in  43  parts  of  ether.  It  is  not 
a  coagulant. 

Its  hemostatic  value  is  purely  local.  If  applied  or  sprayed  upon  a 
bleeding  surface,  in  the  strength  of  10  per  cent,  solution,  it  has  the 
power  to  cause  contraction  of  the  arterioles,  and  in  this  way  will  effi- 
ciently control  any  ordinary  capillary  hemorrhage.  It  will  be  less 
efficient  than  a  coagulant  hemostatic  in  checking  hemorrhage  from  a 
tooth  socket,  because  of  the  deficiency  of  muscle  in  the  vessel  walls  in 
bone.  It  is  a  harmless  drug  when  applied  as  above,  for  one-half  of  a 
fluidounce  (15  mil.)  of  a  10  per  cent,  solution  may  be  used  without 
exceeding  the  maximum  internal  adult  dose.  It  is  useful  in  stopping 
epistaxis  (nosebleed),  the  solution  being  sprayed  into  the  nostril. 

Its  uses  as  anodyne  and  sedative  are  discussed  in  another  place. 

Incomfaiihility . — ^The  aqueous  solution  is  incompatible  with  a  dilute 
solution  of  carbolic  acid;  also  with  spirit  of  nitrous  ether  when  the  latter 
is  acid^  as  it  is  likely  to  be  ordinarily;  also  with  solution  of  tannic 
acid. 

Suprarenalum  Siccum. — Dried  Suprarenal  Glands. — ^Average  dose, 
gr.  4  (0.25  gm.).  Unofficial  preparations:  Epinephrine,  adi'enalin, 
adnephrin,  suprarenin  (synthetic)  and  adrenin.  A  preparation  much 
used  is  a  solution  of  adrenalin  chloride  in  1000  parts  of  physiological 
salt  solution. 

The  active  principle  of  the  suprarenal  glands  was  first  isolated  by 
Abel  (Cushny)  and  has  been  named  epinephrine.  It  is  found  only  in 
the  medullary  portion  of  the  gland.  Takamine  later  isolated  another 
substance,  adrenalin,  which  is  claimed  to  have  all  the  properties  of  the 
gland  substance. 

\\hen  an  extract  of  the  gland  is  injected  into  a  vein,  there  occurs  an 
immediate  rise  of  blood-pressure  which  is  more  or  less  proportional  to 
the  strength  of  the  extract.  The  rise  in  blood-pressure  is  accompanied 
by  a  slowing  of  the  heart  due  to  reflex  stimulation  of  the  cardio-inliibi- 
tory  center  excited  by  the  rise  of  blood-pressure;  when  this  reflex  slow- 


108  ASTRINGENTS  AND  HEMOSTATICS 

ing  is  rendered  impossible  by  cuttino;  the  yr^i  the  rise  in  blood-pressure 
may  reach  an  extraordinary  height.     (Howell.) 

The  chemical  nature  of  the  extract  has  been  worked  out  and  has 
made  it  possible  for  the  chemist  to  prepare  a  synthetic  substitute 
together  with  a  series  of  related  substances  having  a  similar  nature. 

By  careful  studies  it  has  been  found  that  the  extract  of  the  gland 
and  related  substances  cause  the  rise  in  blood-pressure  by  stimulating 
the  nerve  jfibers  of  the  sympathetic  nervous  system  distributed  to  the 
muscular  coats  of  the  bloodvessels.  It  is  on  this  account  that  a 
weak  solution  of  the  extract  is  used  to  stop  hemorrhage.  While 
this  substance  will  stop  hemorrhage  by  constricting  the  arterioles,  it 
reduces  the  coagulability  of  the  blood  and  secondary  hemorrhage  may 
follow.  It  shoukl  be  applied  locally  and  is  especially  useful  in  capillary 
hemorrhage. 

On  account  of  its  vasoconstrictor  action  it  is  a  useful  adjunct  to  the 
local  analgesic  solutions,  making  them  more  efficient  by  localizing 
the  action  and  lessening  absorption  into  the  circulation. 

The  synthetic  preparations  are  claimed  to  be  more  stable  in  com- 
position and  can  be  boiled  in  solutions  wdiich  are  for  immediate  use. 
For  dental  uses  the  usual  dose  is  1  drop  of  the  1  to  1000  solution  of 
adrenalin,  or  of  the  synthetic  preparations,  to  each  cubic  centimeter 
of  the  anesthetic  solution  with  a  maximum  of  5  drops  at  any  one  time 
(Prinz). 

Acidum  Gallicum. — Gallic  Acid  [CvHeOs  +  H2O].  Average  dose, 
gr.  15  (1  gm.).  An  organic  acid,  prepared  from  tannic  acid,  having  a 
rather  uncertain  reputation  as  a  general  styptic — i.  e.,  acting  through- 
out the  system  after  absorption  into  the  circulation.  It  occurs  in 
whitish  crystals,  having  an  astringent  taste,  soluble  in  87  parts  of  water, 
in  about  5  parts  of  alcohol,  and  in  10  parts  of  glycerin.  It  is  acid  in 
reaction.  It  does  not  coagulate  albumin,  therefore  it  has  no  appreciable 
local  action.  It  may  be  given  internally  in  a  dose  of  from  5  to  20  grains 
(0.3-1.3  gm.).  It  is  not  much  to  be  relied  upon,  still  it  is  recommended 
by  some  in  the  hemorrhagic  diathesis  and  to  control  internal  hemor- 
rhages that  cannot  be  reached  by  local  medication. 

Ergota. — Ergot  of  Rye. — This  fungus,  which  replaces  individual 
seeds  of  the  grain,  is  sometimes  called  "spurred  rye."  The  pieces  are 
one-half  to  one  inch  long,  fusiform,  slightly  curved,  purplish-black, 
hard,  and  breaking  transversely. 

Preparations : 

ExTRACTUM  Ergot.^.    Average  dose,  gr.  4  (0.25  gm.). 


VASCULAR  ASTRINGENTS 


109 


Fluidextractum  Ergots.  Average  dose,  TU  30  (2  mils.).  While 
this  drug  contains  several  alkaloids,  none  is  regarded  as  representing  its 
full  action,  therefore  the  preparations  of  the  whole  drug  are  preferred. 


Fig.  3. — Ergotized  rye. 

Uses  as  a  Hemostatic.  —  Ergot  is  really  useful  only  as  it  induces 
contraction  of  unstriped  muscle  in  the  arterioles.  Capillary  hemor- 
rhages that  cannot  be  treated  locally  call  for  its  administration  by 
stomach  or,  in  emergency,  hypodermically.  The  fluidextract  is  the 
preparation  most  commonly  employed,  in  doses  of  J-l  fluidram  (1-4 
mils.).  In  hemophilia  (hemorrhagic  diathesis)  it  is  one  of  the  drugs 
recommended.     It  should  never  be  used  in  case  of  hemorrhage  from  a 


110  ASTRINGENTS  AND  HEMOSTATICS 

good-sized  vessel,  for  fear  of  increasing  the  flow  through  the  rise  of 
arterial  pressure  which  the  drug  produces.     (Plate  I.) 

It  is  one  of  the  drugs  used  to  control  postpartum  hemorrhage.  This 
dangerous  complication  after  labor  is  due  to  relaxation  of  the  unstriped 
muscle  which  is  so  abundant  in  the  parturient  uterus.  Ergot  stimulates 
this  to  powerful  contraction,  thereby  closing  up  the  uterine  sinuses 
from  which  the  bleeding  has  occurred. 

Cotarninse  Hydrochloridum. — Cotarnine  Hydrochloride. — Stypticin. 
— [C12H14O3NCI].  Average  dose,  gr.  1  (0.06  gm.).  A  yellow  crys- 
talline, odorless  powder,  derived  from  narcotin,  an  opium  alkaloid. 
It  is  very  soluble  in  water  and  in  alcohol,  and  is  neidral.  It  causes 
contraction  of  the  unstriped  muscular  tissue  of  arterioles  and  of  the 
uterus  and  is,  therefore,  used  in  hemorrhages  from  small  vessels  and 
from  the  uterus.     It  may  be  applied  locally  or  given  internally. 

Hydrastininae  Hydrochloridum. ^ — Hydrastinine  Hydrochloride  [Cn 
H11O2X.HCI].  Average  dose,  gr.  \  (0.01  gm.).  Hydrastinine  is  an 
artificial  alkaloid  obtained  by  oxidizing  hydrastine,  an  alkaloid  of 
hydrastis.  It  is  an  odorless  white  powder,  very  soluble  in  water  and  in 
alcohol,  and  is  neidral  or  slightly  acid.  It  is  used  internally  to  secure 
constriction  of  arterioles  both  in  hemorrhages  and  in  catarrhal  conditions. 

Remedies  that  Favor  Coagulation  of  the  Blood  by  Reducing 
Blood-pressure. 

Besides  the  application  of  cold,  which  has  been  considered  in  the 
earlier  part  of  the  chapter,  there  are  several  agents  which  comprise 
the  group  of  arterial  sedatives.  The  most  prominent  of  these  are: 
^  Aconitum. — The  root  of  Aconitwn  naiJeUvs.  The  tincture  is  the 
preparation  commonly  used,  the  average  dose  of  which  isTU  5  (0.3  mil.). 
For  its  precise  action,  see  Plate  XIV,  under  Sedatives. 

Veratmm. — The  root  of  Veratrum  mride.  This  drug  is  so  similar  in 
action  and  uses  to  aconite  as  to  require  no  special  discussion  here. 
Average  dose  of  the  tincture,  lU  8  (0.5  mil.). 

Remedies  that  Increase  the  Coagulant  Property  of  the  Blood. 

Within  recent  years  there  has  been  a  decided  gain  in  our  resources 
for  treating  cases  of  persistent  hemorrhage  due  to  various  causes, 
including  those  that  present  deficient  coagulation  of  the  blood.  The 
remedies  employed  may  not  all  act  in  the  same  way,  but  each  has  been 


PLATE    I. 


ERGOT. 

A  fungus  replacing  the  grain  of  rye. 


Classified  as : 
Oxytocic. 
Vasoconstrictor. 
Hemostatic. 

Physiologic  action : 

Nervous  System. 

Brain.     Not  affected. 

Medulla.     Not   affected 
therapeutic  doses. 

Spinal  cord.  Stimulates 
center  for  uterine  contrac- 
tion in  lower  part  of  cord. 

Muscular  System. 

Stimulates  unstriped  muscle, 
— noted  especially  in  the  ar- 
terioles and  gravid  uterus. 
The  vasoconstrictor  effect, 
and  the  consequent  inter- 
ference with  the  capillary 
circulation,  are  so  decided, 
that  gangrene  may  result 
from  its  prolonged  use. 

Circulation.  Arterial  pressure 
may  be  increased,  but  not 
constantly. 

Heart.  May  be  slowed,  but 
influence  not  definite. 

Capillary  area.  Arterioles 
contracted  chiefly  by  local 
vasomotor  stimulation. 

Uterus.  Stimulates  uterine  con- 
tractions, mainly  by  local 
action  upon  the  uterus. 


Pelvic  Plexus 


Eed  color  indicates  stimulation. 


REMEDIES  THAT  INCREASE  COAGULANT  PROPERTY  OF  BLOOD     111 

sufficiently  successful  to  entitle  it  to  trial  in  any  severe  hemorrhage  and 
particularly  in  cases  of  hemophilia.  Since  it  is  generally  held  that 
calcium  salts  are  essential  to  the  blood  reactions  that  precede  coagula- 
tion, these  have  come  to  be  used  with  confidence  in  persistent  hemor- 
rhages.    The  chloride  and  lactate  are  efficient. 

Calcii  Chloridum. — Calcioi  Chloride  [CaClo]. — [Do  not  confuse  with 
chloride  of  lime,  a  chlorine  disinfectant  and  bleaching  agent.]  Average 
dose,  gr.  8  (0.5  gm.). 

Chemically  pure  calcium  chloride  occurs  usually  in  hard  white  frag- 
ments, which  are  very  deliquescent,  odorless  and  have  a  sharp,  saline 
taste.  It  is  neutral,  soluble  in  1.2  parts  of  water  and  in  10  parts  of 
alcohol.  When  given  internally  it  is  believed  to  increase  the  coagula- 
bility of  the  blood.  Good  reports  have  been  made  of  its  value  in  hemo- 
philia, used  both  locally  and  internally.  A  dose  of  5-10  grains  (0.3-0.6 
gm.)  may  be  given  every  four  or  six  hours.  For  local  application  a 
5  or  6  per  cent,  solution  in  water  has  been  employed.  Parry*  reports 
a  case  of  hemophilia  in  which  a  persistent  and  alarming  hemorrhage 
from  the  gums  was  checked  by  the  local  application  of  a  6.25  per  cent, 
solution  (30  grains  to  the  fluid  ounce).  This  drug  certainly  deserves  a 
trial  in  any  case  of  persistent  hemorrhage. 

Calcii  Lactas.— Calcium  Lactate  [Ca(C3H503)2  +  SHoO].— Average 
dose,  gr.  8  (0.5  gm.).  This  is  the  hydrated  form  of  the  salt.  It  occurs 
in  white,  granular  form  or  in  powder,  odorless  and  nearly  tasteless.  It 
is  soluble  in  20  parts  of  water,  almost  insoluble  in  alcohol.  Usually 
neutral.  Though  less  soluble  than  the  chloride,  it  is  better  tolerated 
by  the  stomach  in  case  of  prolonged  use  and  seems  to  be  equally  efficient. 

Gm.  or  mil. 

I^ — Calcii  lactatis     - 6  (5iss) 

Aqua; 120  (f§iv)— M. 

Sig. — One  to  two  teaspoonfiils  every  four  hours. 

Gelatinum. — Gelatin. — Gelatin  is  soluble  in  hot  water,  acetic  acid  or 
glycerin.  It  is  insoluble  in  cold  water,  but  absorbs  from  five  to  ten  times 
its  own  weight,  forming  a  jelly.  Obtained  from  the  skins  and  bones  of 
animals,  gelatin  may  be  contaminated  with  the  bacillus  of  tetanus,  the 
spores  of  which  resist  ordinary  sterilization  by  boiling.  Because  of  this, 
Woodf  states  that  "the  hA^Dodermic  use  of  commercial  gelatm  is  not  to 

*  Lancet,  February  21,  1903. 

t  Pharmacology  and  Therapeutics,  2d  ed..  1916,  p.  325. 


112  ASTRINGENTS  AND  HEMOSTATICS 

be  thouglit  of."  The  same  danger  of  tetanus  would  obtain  with  intra- 
venous use,  with  the  added  danger  of  thrombosis.  Therefore  none  but 
a  specially  prepared  gelatin*  should  be  used.  By  mouth  the  dose  is 
5  |-1  (15-30  gm.)  of  the  gelatin,  in  form  of  a  10  per  cent,  jelly,  every 
three  or  four  hours. 

Thyroideum  Siccum. — Dried  Thyroid  GL.\:^rt)S. — Average  dose,  gr.  1| 
(0.1  gm.).  Both  the  extract  of  the  th\Toid  gland  of  the  sheep  or  of 
other  domestic  animals,  and  the  dried  gland  substance  itself,  have 
given  such  striking  results  in  the  treatment  of  myxedema,  that  its 
administration  has  been  resorted  to  experimentally  in  many  conditions. 
Especially  in  disorders  of  nutrition  and  in  diseases  of  the  circulating 
fluids,  where  absence  of  the  thyroid  secretion  might  be  a  causative 
factor,  this  substance  has  been  tried.  Regarding  its  value  in  hemo- 
philia, a  very  satisfactory  result  is  reported  of  a  case  by  Fuller. f  The 
patient  was  a  boy,  aged  fifteen  years.  Four  maternal  uncles  and  two 
elder  brothers  had  bled  to  death.  The  patient  had  frequent  copious 
hemorrhages  from  the  nose  and  also  bled  se\'erely  with  the  loss  of  tem- 
porary teeth.  For  a  year  he  had  been  in  a  very  weak  condition  caused 
by  spontaneous  attacks  of  hemorrhage  from  the  kidneys.  After  failure 
with  the  usual  remedies,  5  grains  (0.3  gm.)  of  thyroid  extract  were  given 
three  times  daily.  After  the  second  dose  the  bleeding  ceased.  The 
case  was  reported  nine  months  after,  during  which  time  there  had  been 
no  recurrence  of  hemorrhage. 

While  this  remedy  may  be  useful  in  an  occasional  case  only,  it  merits 
a  trial  in  any  condition  attended  by  persistent  hemorrhage. 

Blood  Serum. — Precipitated  Blood  Serum  (not  official). — An 
anhydrous,  sterile  powder,  readily  soluble  in  water.  The  usual  dose  is 
8  grains  (0.5  gm.)  dissolved  in  sterile  water  and  given  subcutaneously, 
which  is  equivalent  to  10  mils,  of  whole  serum,  and  this  may  be  repeated 
frequently.  Human  blood  serum  and  also  serum  from  the  blood  of 
the  horse  and  the  rabbit  have  been  used  with  marked  success  in 
persistent  hemorrhages  where  coagulation  is  deficient.  The  results 
reported   by  Welch  J   in   cases   of  hemorrhages   in  newborn  children, 

*  "Under  the  name  of  Gelatina  slerilizate  pro  injectione,  Merck  has  marketed  a 
10  per  cent,  solution  manufactured  from  specially  selected  material  and  sterilized 
by  heating  to  11.5°  C.  Of  this  preparation  5f  2—4,  representing  I5  to  3  drams  of 
gelatin,  may  be  injected  subcutaneously,  preferably  after  dilution  with  hot  physio- 
logical salt  solution."     Ibid. 

t  Medical  News,  February  28,  190.3. 

t  Am.  Jour.  Medical  Sciences,  1910,  p.  800. 


REMEDIES  THAT  CAUSE  DIRECT  PRESSURE  113 

and  by  Clowes  and  Busch*  in  a  variety  of  cases,  with  reports  by  other 
observers,  have  given  blood  serum  an  important  place  among*  our 
remedies.  The  precipitated  serum  is  preferred  to  fresh  serum,  and  that 
of  the  horse  is  most  satisfactory.  The  conclusions  of  Clowes  and 
Busch  in  regard  to  this  remedy  are  as  follows  if 

1.  Blood  serum  is  found  to  be  of  considerable  value  in  the  treatment 
of  all  forms  of  hemorrhage  due  to  low  blood  coagulability. 

2.  Human  serum  is  in  no  wise  superior  to  that  of  a  variety  of  animals. 

3.  Blood  serum  precipitated  by  means  of  a  suitable  mixture  of  ace- 
tone and  ether  is  fully  as  effective  as  fresh  serum,  if  not  superior  to  it. 
Precipitated  serum  is  freely  soluble  and  possesses  the  advantages  of 
being  sterile,  always  available,  and  retaining  indefinitely  its  capacity 
to  stimulate  coagulation  of  the  blood. 

4.  The  product  obtained  from  horse  serum  appears  to  yield  more 
uniformly  satisfactory  results  than  that  obtainable  from  the  sera  of 
other  animals,  and  very  seldom  exerts  any  deleterious  influence. 

Remedies  that  Cause  Direct  Pressure  or  Occlusion  of  Vessels. 

Mechanical  Hemostatics. — Under  this  heading  are  included  surgical 
measures,  such  as  pressure,  ligatures  and  torsion.  Pressure  may  be 
made  directly  upon  the  bleeding-point,  or  upon  the  artery  of  supply  at 
some  near  point  where  it  may  be  more  effectually  applied.  Ligatures 
are  intended  to  completely  occlude  the  bleeding  vessel,  leading  to  its 
obliteration  beyond.  Torsion  means  twisting  of  a  vessel.  Small  vessels 
that  are  not  easily  ligated  may  be  treated  in  this  way. 

In  case  of  persistent  bleeding  after  extraction  of  a  tooth,  the  most 
effectual  remedy  is  pressure,  for  the  application  of  which  the  tooth 
socket  and  the  occluding  jaw  opposite  are  well  arranged.  A  cork  may 
be  shaped  with  the  knife  and  file  to  conform  to  the  root  of  the  extracted 
tooth,  and,  after  sterilization  by  boiling,  inserted  into  the  bleeding 
socket.  It  is  also  recommended  that  warm  wax  or  modeling  compound 
be  first  inserted  and  the  cork  pressed  into  it.  A  rather  simpler  method 
will  be  to  roll  hemostatic  cotton  firmly  into  a  cone  of  proper  size  to 
fit  the  socket  tightly.  Its  fibrous  nature  aids  coagulation,  though 
the  cotton  plug  will  be  less  solid  than  a  cork.  After  insertion,  a  cork 
or  firm  pad  of  gauze  is  placed  between  the  plug  occupying  the  socket 
and  the  opposing  jaw,  or  the  teeth  contained  in  it,  so  as  to  have 

*  New  York  Medical  .Journal,  January  4,  1913.  t  Ibid. 


.114  ASTRINGENTS  AND  HEMOSTATICS 

pressure  of  the  necessary  degree  exerted  by  closure  of  the  jaws.  The 
pressure  is  usually  maintained  by  a  bandage  passing  under  the  lower 
jaw  and  about  the  head. 

The  collodion  gronp  act  by  exerting  pressure.  They  are  all  inflam- 
mable, and  must  not  be  handled  in  the  vicinity  of  a  flame. 

Collodium. — Collodion. — ^A  varnish  that  consists  of  a  solution  of  4 
parts  of  p;\Toxylin  in  75  parts  of  ether  and  25  parts  of  alcohol.  It  is 
applied  by  means  of  a  camel's  hair  brush  upon  a  thoroughly  dried 
surface.  By  rapid  evaporation  of  the  liquids  its  volume  contracts,  and 
considerable  pressure  is  exerted  upon  the  underlying  tissue.  It  is 
applicable  only  to  slight  superficial  hemorrhages. 

IncompotihiJify. — Collodion  is  precipitated  by  carbolic  acid. 

Collodium  Flexile. — Flexible  Collodion. — In  this  preparation  2 
parts  of  camphor  and  3  parts  of  castor  oil  are  added  to  95  parts  of 
collodion.  Its  flexible  character  adapts  it  to  use  over  movable  parts, 
such  as  the  lips,  or  about  a  joint. 

Collodium  Stypticum. — Styptic  Collodion  (not  official). — In  this 
the  formula  is  modified  so  as  to  contain  20  per  cent,  of  tannic  acid, 
which  adds  coagulant  power  and  furnishes  a  more  powerfully  styptic 
combination. 


The  class  of  hemostatics  would  not  be  sufficiently  discussed  without 
mention  of  a  drug  not  usually  included  in  the  class,  but  one  that  is 
nevertheless  valued  highly  in  its  distinct  application  to  cases  of  hemor- 
rhage. 

Opium.— (For  description  and  detailed  action,  see  under  Sedatives.) 
This  drug,  of  general  systemic  action,  is  mentioned  here  only  for  its 
value  in  aiding  to  restrain  certain  kinds  of  hemorrhage.  It  cannot  be 
classed  with  any  of  the  preceding  drugs,  for  it  has  neither  coagulant  nor 
vasoconstrictor  action;  but  it  is  by  its  power  to  put  the  system  at  rest 
that  it  becomes  so  valuable  in  the  treatment  of  internal  hemorrhages. 
Bleeding  from  the  lungs  requires  that  cough  be  restrained  and  respira- 
tory excitement  allayed;  intestinal  hemorrhage  requires  that  the  bowel 
be  held  quiet;  and  in  either  case  mental  excitement  and  apprehension 
must  be  removed.  Opium,  or  its  alkaloid,  morphine,  will  accomplish 
all  of  this.  In  fact,  the  element  of  nervous  excitement  may  aggravate 
almost  any  kind  of  bleeding  and  call  for  the  use  of  opium  or  morphine 
for  its  removal.  Morphine  in  moderate  dose  is  usually  employed,  by 
stomach  or,  if  the  case  is  urgent,  hypodermically. 


CHAPTER   X. 
DETERGENTS,  ANTACIDS  AND  ALKALIES. 

DETERGENTS. 

The  term  detergent,  meaning  a  cleansing  agent,  applies  rather  to  one 
of  several  uses  to  which  certain  agents  are  put.  These,  in  their  more 
important  designation,  are  usually  alkalies  or  antiseptics;  therefore, 
it  seems  unnecessary  to  make  a  separate  class  of  detergents.  ]Many  of 
the  alkalies  and  milder  antiseptics  are  well  adapted  to  the  cleansing 
of  the  mouth,  teeth,  throat  and  nasal  chambers,  while  the  stronger 
disinfectants  and  even  corrosive  agents  are  adapted  to  the  cleansing 
of  foul  ulcers,  putrescent  pulp  canals,  etc.  For  the  former  uses,  agents 
that  do  not  coagulate  albumin  will  be  most  useful,  for  a  certain  degree 
of  penetration,  especially  into  the  recesses  between  the  teeth,  is  desir- 
able, which  might  be  hindered  by  coagulation.  For  the  latter  uses, 
destruction  of  diseased  tissue,  bacteria  and  decayed  matter  is  necessary, 
calling  at  times  for  the  strongest  chemical  drugs.  Again,  in  dentifrices 
one  kind  of  detergent  contributes  the  scouring  quality,  as  prepared 
chalk;  another  kind  will  thoroughly  cleanse  all  surfaces  and  remove 
fatty  matter,  as  soap;  and  still  another  may  be  desired  to  exert  a  solvent 
or  a  penetrating  influence.  Hydrogen  peroxide  is  a  very  important 
detergent  besides  being  an  antiseptic.  Its  action  is  a  double  one:  (1) 
Lpon  coming  into  contact  with  blood,  pus  or  loosely  organized  tissue, 
it  is  decomposed,  yielding  nascent  oxygen,  by  which  it  acts  as  an  oxi- 
dizing agent  and  antiseptic.  (2)  The  freeing  of  ox^'gen  causes  gaseous 
expansion,  by  which  foul  materials  may  be  loosened  and  carried  away 
from  the  tissues  mechanically. 

ANTACroS    (ALKALIES). 

Antacids  are  agents  that  are  capable  of  neutralizing  acids  by  reason 
of  either  their  alkaline  or  basic  properties.  Alkalies  are  known  by  their 
power  of  changing  the  color  of  red  litmus  to  blue. 

The  action  of  antacids  is  always  chemical,  for  the  acid  character  of 
a  substance  is  lost  only  through  combination  or  decomposition.     In 


116  DETERGEXTS,  AXTACIDS  AND  ALKALIES 

some  instances,  where  a  simple  alkali  is  used,  such  as  lime-water  or 
magnesia,  the  chemical  change  is  a  simple  one,  while  with  the  use  of 
sodium  bicarbonate  or  prepared  chalk,  there  is  decomposition  with 
evolution  of  carbon  dioxide,  and  new  combinations  result  in  which  the 
acid  quality  is  lost. 

The  importance  in  dentistry  of  the  various  substances  belonging  to 
this  class  is  readily  appreciated.  With  the  tendency  toward  acidity  of 
the  fluids  of  some  mouths;  with  the  vitiation  of  the  same  in  disease; 
and  with  the  very  common  presence  of  fermentation  in  food  particles 
which  are  allowed  to  remain  between  the  teeth,  we  have  factors  of 
prime  importance  in  the  causation  of  caries;  and  in  the  recognition 
of  these  factors  we  have  also  the  basis  upon  which  to  found  our 
prophylaxis.  The  judicious  use  of  antacids  becomes  a  necessity,  at 
least  for  the  purpose  of  meeting  temporary  conditions,  recognizing, 
however,  that  proper  care  of  the  teeth  requires  also  proper  care  of  the 
mdividual  as  to  general  health  and  all  nutritive  processes. 

As  a  rule  that  scarcely  admits  of  exception,  all  mouth  washes  for 
continued  use,  and  all  dentifrices,  should  be  alkaline  or  antacid;  but 
in  the  prevention  of  caries  we  recognize  that  antacids  per  se  do  but  one 
thing — ^they  neutralize  acids.  The  prevention  of  acid  formation  is 
equally  important,  and  involves,  besides  strict  local  cleanliness,  the 
use  of  an  antiseptic  to  arrest  fermentation,  which  is  the  very  common 
source  of  the  acid,  or  the  use  of  an  agent  that  is  both  antacid  and  anti- 
septic. Furthermore,  when  acidity  of  the  oral  secretions  persists  in 
spite  of  local  treatment,  the  condition  of  the  general  system  must  be 
considered,  particularly  as  to  disorders  of  digestion  or  errors  of  diet, 
which  ma>"  be  the  cause  of  the  condition. 

The  difference  in  solubility  of  the  several  antacids  in  ordinary  use 
gives  them  a  wide  range  of  adaptability  in  dental  practice.  To  illustrate: 
For  the  purposes  of  a  mouth  wash  a  soluble  alkali  is  needed;  here 
sodium  bicarbonate,  lime-water  or  borax  are  applicable.  For  use  in 
the  mouth  of  a  young  child,  where  rinsing  the  mouth  is  impracticable, 
the  gelatinous  hydrated  magnesia  may  be  applied  quite  thoroughly  by 
means  of  a  cotton  swab,  or  injected  between  the  teeth  and  the  cheeks, 
where,  because  of  its  thick  consistence,  it  will  adhere  and  remain  in 
contact  for  some  time;  and,  again,  in  case  of  erosion,  where  a  soluble 
substance  would  be  rapidly  washed  away,  the  insoluble  prepared 
chalk  may  be  packed  between  and  about  the  teeth,  and  its  neutralizing 
action  will  continue  for  hours,  or  through  the  night  if  applied  at  bed- 
time. 


ANTACIDS  117 

The  excessive  or  continuous  use  of  antacids  may  disturb  gastric 
digestion  to  just  the  extent  that  they  are  allowed  to  reach  the  stomach 
during  the  first  two  or  three  hours  after  meals.  During  this  time  the 
natural  acidity  of  the  gastric  juice  is  needed  and  the  entrance  of  much 
alkali  mto  the  stomach  might  hinder  digestion  by  neutralizing  the  acid. 
Otherwise  no  harm  is  likely  to  arise  from  their  use. 

Soaps. — Soaps  are  compounds  of  the  ordinary  fat  acids  (oleic,  palmitic; 
and  stearic)  with  bases.  In  the  process  of  saponification,  by  boilmg  a 
fat  with  a  base,  the  fat  is  decomposed,  glycerin  is  set  free,  and  the  fat 
acids  combine  with  the  base.  Strictly  speaking,  all  metallic  salts  of 
oleic,  palmitic  and  stearic  acids  are  soaps;  but  only  those  of  potassium, 
sodium  and  ammonium  are  soluble.  Whatever  the  consistence  of  the 
oil  or  fat  emplo}'ed,  its  reaction  with  sodium  will  produce  a  hard  soap 
and  with  potassium  a  soft  soap.  Lead  plaster  is  a  familiar  example 
of  an  insoluble  soap. 

Sapo. — Soap. — Wkiie  Castile  Soap. — It  occurs  as  a  white  or  whitish 
solid  prepared  from  sodium  hydroxide  and  olive  oil.  It  should  be 
hard,  but  easily  cut  M^hen  fresh,  and  free  from  rancid  odor.  It  has  an 
unpleasant  alkaline  taste  and  an  alkaline  reaction.  It  is  soluble  in 
water  and  in  alcohol.  It  contains  about  21  per  cent,  of  water,  which 
may  be  largely  removed  by  drying  at  an  elevated  temperature,  when 
the  soap  may  be  more  readily  pulverized.  It  is  capable  of  dissolving 
fats,  which  property  gives  it  its  great  value.  ^Medicinally  it  is  alkaline 
and  somewhat  antiseptic,  possessing  detergent  qualities  in  marked 
degree.  Its  chief  dental  use  is  in  dentifrices,  where,  in  powdered  form, 
it  may  be  mixed  with  any  other  agent  in  common  use.  As  soap  is 
irritating  to  the  mucous  membrane,  unless  well  diluted,  the  mixture 
should  not  contain  more  than  25  or  30  per  cent. 

Colored  or  marhled  castile  soap  is  less  pure,  as  it  contains  ferruginous 
coloring  matter.  It  is  more  strongly  alkaline,  harder,  containmg  only 
about  14  per  cent,  of  water,  and  is,  therefore,  more  economical  for 
ordinary  uses. 

Sapo  Mollis. — Soft  Soap. — ^A  soft,  yellowish  or  brownish  mass,  pre- 
pared from  potassium  hydroxide  and  cotton-seed  oil,  and  containing 
an  excess  of  the  alkali.  It  is  freely  soluble  in  water  and  in  alcohol. 
It  has  a  slight  odor  and  alkaline  taste  and  is  irritating  to  mucous  mem- 
branes because  of  the  free  alkali  contained. 

It  is  used  preparatory  to  surgical  operations  as  a  cleansing  agent 
for  the  hands  of  the  operator  and  the  site  of  operation.  For  this  use 
it  is  diluted  with  alcohol  and  the  parts  are  thoroughly  scrubbed  with 


lis  DETERGENTS,  ANTACIDS  AND  ALKALIES 

sterile  brush,  the  sohition  of  soft  soap  and  water.     The  tincture  of  soft 
soap  {linimentum  sapunis  mollis)  contains  65  per  cent,  of  the  soap. 

IjicoinjMtibility. — Sokible  soaps  are  incompatible  with  all  acids  and 
with  earthy  and  metaUic  salts;  they  are  precipitated  in  hard  water,  or 
in  a  solution  of  corrosive  suhlimate,  as  an  insoluble  soap. 

Sodii  Bicarbonas. — Bicarbonate  of  Sodium  [XaHCOs]. — A  white, 
opaque  powder,  having  a  mildly  alkaline  taste,  soluble  in  10  parts  of 
water,  insoluble  in  alcohol.  It  is  alkaline  in  reaction.  Average  dose, 
gr.  15  (1  gm.). 

Although  the  carbonates  of  the  alkalies  are  more  soluble  and  more 
strongly  alkaline  than  the  bicarbonates,  the  latter  are  preferred  for 
dental  uses  because  they  are  milder  and  less  unpleasant  to  the  taste. 
For  similar  reasons  the  sodium  salts  are  preferred  to  the  potassium. 
Sodium  bicarbonate  is  the  one  usually  selected  for  internal  use,  as  it 
answers  every  purpose  of  an  alkali  without  being  at  all  irritating.  In 
stomatitis  due  to  fermentative  conditions  and  in  constitutional  disorders 
that  cause  vitiated  oral  secretions,  this  drug  is  useful  used  alone  or  in 
combination  with  an  antiseptic.  As  a  mouth  wash  or  gargle  it  may 
be  used  freely  in  saturated  solution  (10  per  cent.).  It  may  enter  into 
dentifrices  simply  as  an  alkaline  ingredient,  as  it  is  not  antiseptic  nor 
does  it  contribute  any  scouring  quality.  It  is  useful  to  neutralize 
the  mouth  after  any  acid  or  acid  iron  preparation  has  been  taken  or 
used  locally. 

It  is  used  also,  by  direct  application,  to  lessen  the  sensitiveness  of 
dentine  when  this  is  due  to  acidity.  Internally  the  drug  is  used  to 
neutralize  hyperacidity  in  the  stomach,  and  in  the  various  acid  intoxi-- 
cations  of  the  system,  such  as  rheumatism.  The  internal  dose  is  5-30 
grains  (0.3-2  gm.).  In  connection  with  sterilization  of  instruments  by 
boiling,  sodium  bicarbonate  is  oftentimes  added  to  the  water  in  order 
to  lessen  the  liability  of  rusting. 

Incoinyatihility. — This  salt  is  incompatible  with  all  acids,  producing 
effervescence  with  liberation  of  carbon  dioxide.  In  solution  it  is 
changed  by  boric  acid  into  sodium  carbonate  and  borax,  with  liberation 
of  carbon  dioxide.  (If  carbonate  of  sodium  be  present,  reaction  may 
occur  with  either  magnesium  sulphate  or  mercuric  chloride  in  solution,- 
a  brown-red  precipitate  being  thrown  down.) 

Sodii  Boras.  —  Borate  of  Sodium. — Borax  [Na2B407  +  lOIIoO]. 
A^■erage  dose,  gr.  12  (0.75  gm.).  It  occurs  in  colorless  crystals  or  white 
powder,  having  an  alkaline  taste,  soluble  in  15  parts  of  water  and  in 
about  1  part  of  glycerin,  insoluble  in  alcohol.     It  is  aJkaJine  in  reaction. 


ANTACIDS  119 

non-u'ritating  to  tissues,  and  its  taste  is  bland  and  sweetish.  The 
solution  in  glycerin  is  acid  in  reaction.  (See  below,  under  Incompati- 
bility.) 

This  salt  is  also  known  as  sodium  biborate,  tetraborate  and  pyro- 
borate.  It  occurs  naturally  in  many  volcanic  regions,  our  American 
supply  coming  chiefly  from  Nevada  and  California.  It  is  also  prepared 
artificially  upon  a  commercial  scale. 

In  borax  we  have  an  agent  that  is  both  alkaline  and  antiseptic,  and 
that  may  be  used  freely  in  satm-ated  solution  (6.6  per  cent.).  It  is, 
therefore,  admirably  adapted  to  all  uses  that  call  for  a  mouth  wash 
possessing  the  above  qualities.  In  stomatitis  and  in  thrush  especially 
it  is  a  superior  agent.  The  latter  disease  occurs  mostly  in  young 
infants  where  a  mouth  wash  cannot  be  so  well  employed.  Here,  before 
the  eruption  of  any  teeth,  we  may  use  a  saturated  solution  in  glycerin, 
made  by  dissolving  the  powdered  borax  in  hot  glycerin,  which  will 
insure  saturation  when  it  has  cooled.  Glycerin  itself  is  a  preservative, 
and  the  resulting  thick,  sweet  solution  may  be  applied  by  means  of  a 
swab  to  all  parts  of  the  infant's  mouth.  In  dentifrices  borax  will 
contribute  antacid  and  antiseptic  properties.  This  drug  is  seldom 
given  internally. 

Incompatibility. — Borax  in  saturated  aqueous  solution  is  decom- 
posed by  mineral  acids,  with  the  precipitation  of  boric  acid,  which  is 
slightly  less  soluble.  A  white  precipitate  is  also  thrown  down  by 
corrosive  sublimate. 

Special  interest  attaches  to  borax  because  of  its  peculiar  behavior 
with  certain  other  substances.  Thus,*  "It  is  incompatible  with  muci- 
lage of  acacia,  causing  gelatinization,  which  can,  however,  be  prevented 
by  the  presence  of  sugar;  it  precipitates  many  alkaloids  from  their 
solution,  such  as  cocaine,  morphine,  atropine,  quinine,  etc.,  except 
in  the  presence  of  glycerin;  it  forms  a  damp,  almost  moist,  mixture 
when  triturated  with  alum;  in  the  presence  of  glycerin  it  decomposes 
alkali  carbonates  with  effervescence;  and,  lastly,  while  an  aqueous 
solution  of  borax  shows  an  alkaline  reaction  toward  litmus,  a  solution 
in  glycerm  has  a  decided  acid  reaction,  which  is  changed  to  alkalme 
upon  large  dilution  with  water," 

Liquor  Calcis. — Solution  of  Calcium  Hydroxide. — Lime-water. — 
Average  dose  f5  4  (15  mils.)  or  a  tablespoonful.  An  aqueous  solution 
containing  not  less  than  0.14  per  cent,  of  calcium  hydroxide  [Ca(0H)2]. 

*  The  National  Standard  Dispensatory,  third  edition,  1916,  pp.  1487-8. 


120  DETERGENTS,  ANTACIDS  AND  ALKALIES 

It  is  readily  prepared  by  treating  freshly  slaked  lime  with  water.  It 
is  strongly  alkaline  in  reaction,  almost  tasteless  and  very  agreeable 
to  the  stomach.  It  may  be  used  freely  as  a  mouth  wash  and  to  correct 
undue  aciflity  of  the  stomach.  For  the  latter  purpose  it  is  very  com- 
monly added  to  the  food  of  infants,  especially  in  the  digestive  disorders 
occurring  during  the  summer,  when  the  milk  so  easily  loses  its  normal 
alkaline  quality. 

Incomixiiihility. — Carbon  dio.ride  gas  produces  in  lime-water  a  cloudi- 
ness, due  to  calcium  carbonate.  Oxalic  acid  produces  a  white  precipi- 
tate of  calcium  oxalate.  With  corrosive  sidiUmaie  a  yellowish  precipitate 
occurs,  and  with  calomel  a  black  deposit. 

Magnesii  Oxidum. — Light  Magnesia. — Magnesia  [MgO]. — x\verage 
dose,  gr.  30  (2  gm.).  The  light  magnesium  oxide  is  prepared  by  expos- 
ing light  magnesium  carbonate  to  a  dull-red  heat.  It  is  a  white,  very 
light  powder,  having  a  slight  earthy  taste  and  alkaline  reaction.  It  is 
insoluble  in  alcohol,  almost  insoluble  in  water,  but  when  mixed  with 
15  parts  of  water  and  allowed  to  stand  for  half  an  hour  it  gelatinizes, 
forming  magnesium  hydroxide  or  "milk  of  magnesia."  (See  Magma 
Magnesise,  below.)  This  drug  is  an  agreeable  antacid  for  stomach 
administration,  and  is  at  the  same  time  laxative.  This  combination  of 
properties  makes  it  a  useful  agent  for  the  treatment  of  intestinal  dis- 
orders of  childhood,  the  alkaline  quality  serving  to  neutralize  any 
undue  acidity,  and  the  laxative  action  ridding  the  bowel  of  offensive 
contents.  When  used  thus  internally  it  should  be  given  in  not  less 
than  20  parts  of  water  to  prevent  the  formation  of  a  gelatinous  mass. 

Magnesia  should  be  kept  from  exposure  to  air,  as  it  slowly  absorbs 
moisture  and  carbon  dioxide,  forming  a  carbonate. 

Magma  Magnesise. — Milk  of  Magnesia. — ^Average  dose  f5  2^  (10 
mils.).  A  thick,  white  liquid  containing  about  7  per  cent,  of  magnesium 
hydroxide  [Mg(0H)2]  in  suspension  in  water;  alkaline  in  reaction. 
Milk  of  magnesia  is  one  of  the  most  useful  agents  to  neutralize  acids 
in  the  mouth,  being  ranked  first  by  some  practitioners.  This  prepara- 
tion is  easily  made  in  the  way  mentioned  above  and  it  keeps  well.  Its 
gelatinous  consistence  causes  it  to  adhere  to  the  teeth  and  remain 
about  them  for  a  considerable  time,  which  is  a  decided  advantage. 
In  infants  it  may  be  applied  by  means  of  a  cotton  swab  to  the  inside 
of  the  cheeks  and  throughout  the  mouth.  It  may  be  used  freely  in 
any  mouth  and  at  any  age.  Gi^'en  internally,  it  has  the  antacid  and 
laxative  action  of  magnesia,  the  latter  being  aided  by  following  the 
dose  with  lemon  juice  or  other  mild  acid. 

Inconipatibilify. — Magnesia  is  neutralized  by  acids. 


DILUENTS— WATER— MINERAL  WATERS  121 

Creta  Piaeparata. — Prepared  Chalk  [CaCOs].  Average  dose,  gr.  15 
(1  gm.).  This  substance  is  one  kind  of  calcium  carbonate.  It  occurs 
in  form  of  a  whitish  powder,  which  is  often  moulded  into  the  shape  of 
small  cones.  It  is  odorless  and  nearly  tasteless,  almost  insoluble  in 
water,  insoluble  in  alcohol,  soluble  in  acids  with  effervescence  and 
chemical  change.  It  is  not  properly  an  alkaline  substance,  but  an 
antacid,  i.  e.,  it  neutralizes  acids,  but  does  not  turn  red  litmus  blue.  Its 
action  consists  of  a  chemical  union  with  any  free  acid,  which  displaces 
the  carbonic  acid  of  the  chalk.  It  may  be  used  freely  internally,  as  an 
antacid  in  gastric  and  intestinal  disorders.  While  solubility  of  a  drug 
is  usually  desirable  in  order  to  have  rapid  action,  the  insolubility  of  pre- 
pared chalk  gives  it  a  special  place  in  dentistry.  Having  a  mild  scour- 
ing quality,  and  being  antacid,  it  holds  first  place  as  a  basis  for  tooth 
powders.  Its  insolubility  also  gives  it  a  prolonged  action  as  an  antacid 
so  that  in  a  mouth  with  a  marked  tendency  to  acidity  it  may  be  packed 
between  and  about  the  teeth  upon  retiring,  and  its  action  will  continue 
during  the  night.  This  use  is  regarded  as  very  important  in  progressive 
cases  of  erosion,  where  the  damage  occurs  mostly  at  night,  when  there 
is  less  saliva  secreted  and,  accordingly,  the  secretions  of  the  mouth  do 
not  become  so  well  mixed,  the  mucus  remaining  upon  the  surfaces  of 
the  teeth  and  about  the  gum  margin.  The  extreme  sensitiveness  of 
the  dentine,  which  is  present  in  these  cases,  may  also  be  lessened  by  the 
continuous  use  of  this  agent  within  the  cavities  of  erosion  and  decay 
and  about  the  teeth.  The  accepted  belief  that  sensitiveness  of  dentine 
is  often  due  to  irritation  by  acids,  points  to  the  use  of  prepared  chalk 
during  the  preparation  of  any  cavity  where  sensitiveness  is  marked. 
It  is  well  to  continue  its  use  during  several  days  preceding  the  final 
preparation  for  filling.  (See  Index  of  Drugs  for  preparations  for  internal 
use.) 

Incompaiibility. — In  contact  with  acids  chalk  decomposes  with  effer- 
vescence, caused  by  the  liberation  of  carbon  dioxide. 

DILUENTS.     WATER.     MINERAL  WATERS. 

The  increasing  recognition  of  various  autointoxications  of  the  human 
system  as  the  most  disturbing  factors  in  many  diseases,  brings  into 
prominence  the  use  of  diluents,  especially  water,  in  the  aid  of  normal 
cell  function  thi'ough  free  elimination.  Particularly  after  full  develop- 
ment of  the  body,  in  other  words  after  the  play  period  of  life  has  passed, 
the  tendency  to  less  active  and  a  lessened  amount  of  exercise,  favors 


122  DETERGENTS,  ANTACIDS  AND  ALKALIES 

deficient  oxidation  of  food  substances  and  waste  tissue  materials,  with 
resulting  accumulations  of  partially  elaborated  products,  which  are 
more  or  less  deleterious.  A  distinct  group  of  diseases  related  to  such 
causes,  including  gout,  so-called  lithemia,  fermentative  digestive  dis- 
orders, chronic  rheumatism,  etc.,  give  evidence  of  the  extreme  impor- 
tance of  aiding  cell  elimination  throughout  the  body.  If  with  lessened 
exercise  the  usual  amount  of  food  is  still  taken,  the  conditions  are 
aggravated,  a  superabundance  of  nutriment  being  furnished  to  the 
tissues  whose  oxidation  processes  are  below  normal.  Moreover,  as  age 
advances,  with  development  completed,*  many  of  the  capillary  blood- 
vessels disappear  because  no  longer  needed.  The  capillary  circulation 
is  accordingly  less  active  and,  with  the  factors  of  excessive  food  material 
and  deficient  oxidation  cooperating,  the  tissues  easily  become  clogged, 
so  to  speak,  laying  the  foundation  for  the  diseases  mentioned.  The 
presence  of  arteriosclerosis,  which  means  hardening  of  the  walls  of 
the  arteries,  adds  another  contributing  factor  by  lessening  the  uniform- 
ity of  blood  supply  to  the  capillaries.  The  relation  of  these  conditions 
to  oral  pathology  is  being  emphasized  today  in  classification  and  treat- 
ment of  pericemental  and  alveolar  diseases. 

Uric  acid  is  recognized  as  a  product  of  partial  oxidation  of  nitrog- 
enous waste,  and  has  been  regarded  as  a  prominent  factor  in  gouty 
disorders.  At  the  present  time,  however,  doubt  is  being  thrown  upon 
its  importance  as  a  poison  to  the  system.  Nevertheless  it  stands  with 
a  group  of  substances  arising  in  the  body  through  faulty  cell  activity, 
some  of  which  are  acid  in  nature.  For  the  double  purpose  of  washing 
these  substances  out  of  the  tissues  into  channels  of  elimination  and  of 
diluting  them,  it  is  advisable  to  use  water  freely,  with  or  without 
alkaline  salts  for  antacid  efli'ect.  Various  alkaline  mineral  waters  are 
taken  with  good  results,  and  the  salts  of  lithium  have  had  a  recent 
extensive  use;  but  many  physicians  now  g'we  preference  to  pure  water. 
Distilled  water,  because  of  its  greater  solvent  power,  being  de^•oid  of 
salts,  is  preferred  in  some  conditions.  In  whatever  kind,  the  taking 
of  water  in  the  quantity  of  one  or  two  quarts  daily  is  an  important 
part  of  the  constitutional  treatment  of  these  conditions.  Pure  water  is 
a  diuretic  and  the  addition  of  certain  salts  will  uicrease  this  action,  while 
others  will  induce  a  cathartic  action. 

While  the  natural  mineral  waters  are  useful  according  to  their  saline 
and  alkaline  constituents,  they  are  not  necessarily  superior  to  simple 

*  Balfour,  The  Senile  Heart,  MacMillan  &  Co.,  1894,  p.  14. 


DILUEXTS—WATER^MIXERAL  J]^ ATERS  123 

solutions  of  the  cathartic  and  diuretic  salts,  while  the  latter  permit  of 
modification  which  places  the  kind  and  degree  of  the  saHne  action 
under  our  control.     (See  Cathartics  and  Diuretics.) 

Certain  artificial  combinations,  in  imitation  of  the  formulas  of  popu- 
lar mineral  waters,  are  upon  the  market,  e.  g.,  artificial  Carlsbad  salts. 
These  seem  to  meet  the  demand,  but  their  employment,  as  well  as  that 
of  any  mineral  water,  should  be  based  upon  proper  discrimination  as  to 
indications  for  their  use. 


CHAPTER   XI. 
ANTISEPTICS. 

The  term  antiseptic  in  a  general  sense  applies  to  the  antagonism 
of  sepsis- — i.  e.,  to  whatever  measures  are  employed  to  prevent  the 
growth  and  propagation  of  disease-producing  bacteria,  also  to  counter- 
act their  influence  and  to  remove  their  noxious  products.  If,  however, 
we  anal}'ze  modern  antiseptic  treatment,  we  find  that  the  agents  and 
means  employed  vary  as  to  the  precise  part  they  play  in  bringing  about 
the  result.  One  agent  will  kill  the  bacteria;  it  is,  therefore,  a  germicide. 
Another  will  not  only  destroy  bacteria,  but  will  remove  the  noxious 
properties  of  putrefaction  and  fermentation;  this  is  a  true  disinfectanf. 
Another  will  inhibit  the  growth  and  propagation  of  bacteria  without 
destroying  them  or  removing  their  noxious  products;  this  cannot  be 
designated  otherwise  than  as  a  simjih  aniiseptic — preventing  sepsis,  but 
not  removing  it  when  present.  A  deodorant  is  an  agent  that  removes 
or  corrects  an  offensive  odor. 

It  is  impossible,  however,  to  make  a  distinct  classification  in  accord- 
ance with  these  terms,  for  the  reason  that  many  agents  belong  to  one 
or  another  class,  according  to  the  strength  in  which  they  are  employed, 
being  in  strong  solution  germicidal  or  disinfectant,  and  in  weak  solution 
simply  antiseptic.  Other  conditions,  such  as  character  of  solvent, 
temperature  of  solution  and  character  of  bacteria,  also  modify  our 
designation  of  the  several  agents.*  An  antiseptic  may  be  germicidal 
to  one  kind  of  bacterium  and  only  inhibitory  to  the  growth  of  another. 
To  the  writer  it  seems  better  to  employ  the  term  aniisepiic  in  its  general 
inclusive  sense,  to  cover  all  agents  employed  to  prevent,  counteract 
and  remove  the  influence  of  disease  germs,  and  to  further  designate 
differences  of  action  by  using  the  adjective  terms  germicidal  and  dis- 
infectant. 

*  The  efficiency  of  antiseptics  can  be  stated  only  in  a  relative  manner,  since,  as 
yet,  there  are  no  generally  accepted  standards.  Rideal  and  Walker  have  ijroposed 
the  "phenol  coefficient"  but  the  results  have  not  justified  its  general  acceptance. 
Briefly  stated  it  means  the  result  arrived  at  l)y  dividing  the  figure  indicating  the 
degree  of  dilution  of  the  disinfectant  that  kills  an  organism  in  a  given  time  by  that 
expressing  the  degree  of  dilution  of  phenol  that  kills  the  same  organism  in  the  .'ame 
time  under  exactly  similar  conditions. 


ANTISEPTICS  125 

The  intelligent  use  of  antiseptics  has  been  a  matter  of  development 
during  the  past  forty  years,  following  closely  the  progress  made  in 
the  science  of  bacteriology.  When  Pasteur  in  1857  proved  that  the 
processes  of  fermentation  and  putrefaction  were  caused  by  the  presence 
and  growth  of  organisms,  the  way  was  prepared  for  investigation  of 
septic  conditions  and  special  diseases.  In  1875  Lister  set  forth  the 
germ  theory  as  applied  to  the  infection  of  wounds.  His  work  and 
methods  were  a  great  step  toward  realizing  the  aseptic  surgical  methods 
of  today  and  are  referred  to  by  an  eminent  surgical  writer*  as  having 
"brought  about  an  entire  revolution  in  surgery  and  surgical  technic, 
and  an  entire  reversal  of  the  statistics  of  operations;  where  thousands 
formerly  died,  thousands  now  live,  their  lives  being  indirectly  due  to 
the  labors  of  this  one  man  and  his  following." 

Since  then  the  specific  organisms  of  many  diseases  have  been  dis- 
covered and  the  application  of  antiseptic  agents  has  become  more 
precise  and  the  results  more  definite. 

In  dental  practice  antiseptics  must  be  regarded  in  relation  to  widely 
differing  structures,  as  presented  by  the  teeth,  in  their  very  hard  min- 
eral character,  by  the  softer  tissues  of  the  mouth,  and  by  the  extremely 
delicate  and  sensitive  tooth  pulp.  Indeed,  two  quite  distinct  fields 
are  before  the  dental  specialist  in  his  study  of  antiseptic  therapeutics. 
He  has  now  to  select  his  agents  for  mouth  disinfection  and  again  for 
tooth  disinfection.  For  mouth  treatment  his  antiseptics  must  be  selected 
with  regard  to  safety  of  the  soft  tissues;  for  tooth  disinfection  the 
application  is  of  such  limited  extent,  and  the  soft  structures  are  so  well 
excluded,  that  the  main  question  is  that  of  efficiency,  the  very  strongest 
escharotics  being  eligible  for  use;  then  also  treatment  of  the  tooth  pulp 
will  require  the  selection  of  agents  especially  adapted  to  its  condition. 
These  considerations  will  lead  to  the  use  of  the  terms  "  mouth  disin- 
fection" and  "tooth  disinfection"  in  the  discussion  of  antiseptics. 

The  ideal  condition  to  be  aimed  at  in  all  surgical  work  is  that  of 
asepsis,  or  absence  of  disease  germs.  The  operator  seeks  to  begin  his 
operation  with  perfect  asepsis.  To  this  end  his  instruments  are  steri- 
lized by  boiling,  and  the  dressings  by  dry  heat  at  a  temperature  of  230° 
or  over,  while  his  hands  and  the  site  of  operation  are  treated  with 
suitable  disinfectants.  Asepsis  of  the  mouth  is  difficult  of  attainment, 
but  the  site  of  operation  may  be  made  relatively  aseptic  after  exclusion 
of  the  fluids  by  a  sterile  rubber  dam,  and  the  condition  then  maintained 

*  Park's  History  of  Medicine,  second  edition,  p.  261. 


126  AXTISEPTICS 

through  the  use  of  sterile  instruments  by  sterile  hands.  The  appli- 
cation of  tincture  of  iodine  to  the  site  of  operation  is  most  relied  upon 
today  to  secure  asepsis. 

The  importance  of  thoroughly  sterilizing  all  instruments  that  have 
been  used  in  the  mouth,  after  each  dental  operation,  must  be  insisted 
upon.  There  can  be  no  doubt  that  one  must  frequently  operate  in  a 
syphilitic  mouth  without  being  aware  of  it,  because  the  lesions  may  be 
slight  or  invisible.  In  secondary  syphilis  the  danger  of  carrying  the 
disease  to  another  mouth  or  of  infecting  a  chance  lesion  upon  the 
hand  is  very  great,  and  preventable  with  certainty  only  by  sterilization 
of  instruments  and  appliances.  Alcohol  has  been  regarded  as  a  disin- 
fectant for  this  piu-pose,  but  its  value  is  questionable.  Absolute 
certainty  should  require  sterilization  by  heat. 

Acidum  Boricum. — Boric  Acid. — Boracic  Acid  [H3BO3]. — Average 
dose,  gr.  8  (0.5  gm.).  This  occurs  in  transparent,  colorless  scales  or 
crystals,  nearly  tasteless,  soluble  in  18  parts  of  water,  18  parts  of  alcohol, 
and  4  parts  of  glycerin.  It  is  sligJitly  acid  in  reaction.  This  substance 
is  found  in  various  parts  of  the  globe  chiefly  in  the  form  of  natural 
borates,  the  American  market  being  supplied  from  the  borax  regions  of 
California. 

The  saturated  aqueous  solution  of  this  drug  {0.0  per  cent.)  is  largely 
used  as  a  mild  antiseptic  wash.  It  is  non-irritating,  therefore  may  be 
applied  to  the  most  delicate  tissue.  As  an  eye  wash  it  is  much  used. 
It  may  be  employed  freely  as  a  mouth  wash,  the  only  objection  being 
its  slight  acidity.  However,  it  must  be  said  that  it  possesses  no  real 
advantage  over  its  sodium  salt.  In  powdered  form  it  is  used  in  tooth 
powders  or  dusted  upon  ulcers  or  wounds. 

Incompatibility. — In  aqueous  solution  boric  acid  is  decomposed  by 
carbonates,  with  the  formation  of  borates. 

Glyceritum  Boroglycerini. — Glycerite  of  Boroglycerix. — Whenever 
a  stronger  preparation  of  boric  acid  than  the  saturated  solution  is 
desired,  it  may  be  had  in  the  official  glycerite  of  boroglycerin,  which 
contains  31  per  cent,  of  boric  acid  incorporated  by  chemical  union  with 
glycerin.  This  may  be  used  in  full  strength  or  diluted.  It  is  neutral 
in  reaction. 

Sodii  Boras. — Borax. — Average  dose,  gr.  12  (0.75  gm.).  This  salt 
has  been  discussed  under  Antacids.  As  an  antiseptic  it  may  be  used 
freely  in  saturated  solution  (0.6  per  cent.)  as  a  mouth  wash,  or  the 
crystal  may  be  allowed  to  dissolve  in  the  mouth.  Borax  deserves  a 
large  use  as  a  mild  antiseptic  since  it  possesses  every  essential  quality 


PHENOL  LIQUEFACTUM  127 

of  a  mouth  antiseptic,  though  one  of  the  class  of  weaker  agents.  It  is 
alkaline,  non-irritating,  almost  tasteless  and  non-toxic.  Dobell's  solu- 
tion* is  a  very  useful  combination. 

A  saturated  solution  in  glycerin  (equal  parts  of  each)  is  very  efficient 
in  the  removal  of  the  thrush  fimgus  (oidium  albicans),  which  is  so 
often  seen  in  the  mouths  of  bottle-fed  infants.  The  thick  consistence 
of  this  solution  is  advantageous  in  that  it  thereby  adheres  to  the  mucous 
membrane  for  some  time.     It  should  be  applied  several  times  daily. 

Sodii  Perboras. — Sodioi  Perborate  [XaBOs  +  4H2O]. — ^Average 
dose,  gr.  1  (0.06  gm.).  It  occurs  as  white  granules  or  powder,  odor- 
less, with  a  saline  taste,  stable  in  cool  dry  air,  but  losing  oxygen  in 
warm  or  moist  air;  soluble  ui  water;  alkaline  in  reaction.  It  should 
contain  not  less  than  9  per  cent,  of  available  oxygen. 

Sodium  Perborate  makes  an  efficient  antiseptic  mouth  wash  in  ulcer- 
ative conditions  of  the  mouth.  It  is  important  that  it  be  prepared 
fresh  each  time,  as  the  solution  does  not  keep  well.  A  teaspoonful  in 
one-half  glass  of  water  is  a  proper  strength.  It  produces  its  action  by 
the  liberation  of  nascent  oxygen. 

Phenol. — Carbolic  Acid. — ^Average  dose,  gr.  1  (0.06  gm.).  This 
substance  has  been  considered  in  its  action  upon  the  tissues,  under 
Escharotics.  In  dilute  solutions  it  is  one  of  the  most  generally  useful 
antiseptics.  Although  slightly  acid  in  reaction,  this  substance  is  not 
an  acid,  chemically  speaking.  It  is  a  coagulant  when  used  in  strong 
solution,  and  while  this  property  may  be  a  factor  in  its  antiseptic  action, 
its  germicidal  power  may  be  thereby  lessened  b}'  interference  with 
penetration. 

Phenol  Liquefactum. — Liquefied  Phenol,  containmg  not  less  than 
87  per  cent,  of  absolute  phenol,  is  convenient  for  ready  use  and  for 
diluting. 

Phenol  is  soluble  in  about  15  parts  of  water,  giving  a  saturated  solution 
of  about  6  per  cent.     This  is  too  strong  for  use  upon  mucous  membranes, 

*  The  formula  of  Dol^ell's  solution,  as  given  in  the  National  Formulary  under  the 
title  Liquor  Sodii  Boratis  Co?npositus  is: 


Gm.  or  mil 

I^ — Sodii  boratis 15 

Sodii  bicarbonatis      . 15 

PhenoUs  (crystals) 3 

Glycerini 35 


(3iv) 
(5iv) 
(gr.  xlv) 

(fSi) 


Aquas q.  s.  ad     1000  (Oij) 

Dissolve  the  salts  in  one-half  of  the  total  quantity  of  water,  then  add  the  glycerin 
and  the  phenol,  previously  liquefied  by  warming,  and,  lastly,  enough  water  to  make 
up  the  total  quantity. 


128  ANTISEPTICS 

but  may  be  used  upon  the  skin  with  care.*  It  is  the  proper  strength  for 
occasional  disinfection  of  the  hands,  but  its  frequent  use  will  make  the 
skin  rough,  because  of  its  coagulant  action.  As  a  mouth-wash  or 
gargle  it  has  the  advantage  of  being  slightly  analgesic,  but  it  should  not 
be  used  stronger  than  1  per  cent.  The  slight  acidity  may  be  counter- 
acted by  combining  a  solution  of  sodium  bicarbonate  with  it.  For 
the  purpose  of  tooth  disinfection  the  pure  phenol  may  be  used  in  small 
quantity  with  due  care. 

It  is  remarkable  that  the  continuous  application  of  a  solution  as 
wxak  as  5  per  cent,  has  been  followed  by  gangrene,  the  result  probably 
of  thrombosis.  This  is  especially  liable  to  occur  in  a  finger  or  toe  wdiere 
all  ^'essels  of  supply  are  equally  affected.  The  local  analgesic  action 
undoubtedly  aids  in  lowering  the  vitality  of  the  part  and  prevents 
painful  sensation,  which  otherwise  might  give  warning  of  the  danger. 

It  may  be  said  of  this  agent  that,  having  been  one  of  the  first  sub- 
stances proposed  as  an  antiseptic  and  disinfectant,  it  has  held  its  place 
for  more  than  forty  years  as  one  of  the  best  drugs  of  the  class.  A 
solution  of  1  in  250  will  quickly  destroy  lower  forms  of  vegetable  life 
and  check  fermentation,  a  1  per  cent,  solution  may  be  relied  upon  as  a 
general  antiseptic,  while  a  5  per  cent,  .solution  is  an  efficient  disinfectant. 

As  to  its  germicidal  power,  Harrington  found  that  a  5  per  cent,  solu- 
tion destroyed  the  Staphyhcoccus  pyogenes  mireus,  the  most  common 
and  most  resistant  pus  organism,  in  two  minutes;  a  2.5  per  cent,  solu- 
tion requu'ed  four  minutes,  f 

In  saturated  solution  it  is  useful  to  keep  instruments  in  sterile  con- 
dition during  an  operation.  It  has  no  action  upon  metals;  therefore 
instruments  may  be  disinfected  by  its  use  in  full  strength,  bearing 
in  mind  always  that  any  albuminous  matter  will  be  coagulated  by  it 
instead  of  being  removed.  The  combination  known  as  liquor  sodii 
carbolatisj  contains  50  per  cent,  of  carbolic  acid. 

*  A  wet  dressing  of  not  stronger  than  5  per  cent,  phenol  has  caused  gangrene  of 
a  finger,  after  a  twenty-four  hour  apphcation.  See  Hare's  Therapeutics,  thirteenth 
edition,  1909,  p.  400. 

t  Annals  of  Surgery,  October,  1904. 

%  Liquor  sodii  carbolnii.s  (N.F.)  corresponds  very  closely  to  the  proprietary  prepara- 
tion known  as  i)hcnol  sodique.     It  has  the  following  formula: 

Gm.  or  mil. 

I^— Phenolis  (crystals) 50 

Sodii  hydroxidi 3  5 

Aquaj 46  5 

Dissolve  the  soda  in  the  water,  add  the  j)lienol,  and  warm  gently  \mtil  it  is  dis- 
solved. 

This  i)reparati()n  should  lie  freshly  made.  Used  in  fvdl  strength  this  combination 
would  be  caustic. 


TRICHLORPHENOL  129 

Internally  phenol  is  a  valuable  antiseptic.  In  doses  of  ^-2  minims 
(gm.  0.03-0.12),  well  diluted,  it  is  used  to  arrest  fermentation  in  the 
stomach  and  intestines,  an  advantage  of  its  use  being  that  it  does  not 
disturb  digestion. 

When  employing  this  drug,  it  must  always  be  borne  in  mmd  that  it 
is  a  poison — corroswe  when  applied  in  full  strength  to  tissue;  and  also 
a  systemic  poison  when  absorbed  in  quantity,  producing  irritation  of  the 
kidneys  which  may  result  in  nephritis;  therefore,  caution  should  always 
attend  its  use,  and  in  view  of  the  frequency  of  poisoning  by  carbolic  acid 
every  practitioner  should  be  prepared  to  treat  the  same  in  emergency. 
Albumin  is  a  true  antidote,  while  alcohol  has  some  restorative  action 
upon  tissues;  soluble  sulphates  have  been  employed.  (See  under 
Escharotics.) 

Incompatibility. — Phenol  will  coagulate  albumin  and  collodion.  In 
aqueous  solution  a  white  precipitate  occurs  with  bromine  water,  with 
ferric  chloride  a  violet  color  is  produced,  and  with  solution  of  antipyrin 
a  white  precipitate  occurs.  When  the  saturated  aqueous  solution  is 
mixed  with  a  solution  of  cocaine  hydrochloride  a  white  precipitate  may 
occur. 

Cresol  ~  Tricresol.  — Cresylic  Acid  [CyHgO].— Average  dose,  lU  1 
(0.05  mil.).  A  mixture  of  isomeric  cresols  obtained  from  coal-tar. 
It  is  a  nearly  colorless  liquid,  becoming  yellowish  or  brownish  upon 
prolonged  exposure  to  light.  Its  odor  is  similar  to  that  of  phenol.  It 
is  soluble  in  50  parts  of  water  and  in  alcohol  and  glycerin.  The  uses 
of  this  substance  are  the  same  as  those  of  phenol.  It  is  believed  to  be 
a  more  powerful  disinfectant.  A  5  per  cent,  solution  has  been  found 
to  destroy  Staphylococcus  pyogenes  aureus  in  two  minutes.* 

Liquor  Cresolis  Compositus. — Lysol. — This  solution  contains  50  per 
cent,  of  cresol,  with  linseed  oil  and  potassium  hydroxide.  It  is  liquid 
cresol  soap.  It  mixes  with  water  readily  and  in  solution  of  from  1  to 
5  per  cent.,  it  is  largely  used  as  a  general  antiseptic  wash  and  disin- 
fectant. It  is  a  good  hand  disinfectant,  although  its  odor  may  be 
objectionable. 

Trichlorphenol  [CeHaClsOH]  (not  official).— The  action  of  chlorine 
upon  phenol  produces  a  series  of  bodies  whose  antiseptic  power  exceeds 
that  of  phenol.  Of  these  trichlorphenol  is  a  definite  crystalline  sub- 
stance, soluble  in  alcohol  and  ether.  According  to  Nenckif  a  2  per 
cent,  solution  was  found  to  be  more  active  than  a  5  per  cent,  solution 

*  Harrington,  Annals  of  Surgery,  October,  1904. 
t  U.  S.  Dispensatory,  eighteenth  edition,  p.  1615. 


130  ANTISEPTICS 

of  phenol  and  only  a  little  weaker  than  1  to  1000  solution  of  bichloride 
of  mercury. 

Creosotum. — Creosote. — Oil  of  Smoke. — ^Average  dose,Tn,  4  (0.25  mil.) . 
A  mixture  of  phenols,  chiefly  guaiacol  and  creosol,  obtained  by  distilla- 
tion of  wood-tar.  In  addition  to  the  discussion  of  this  substance  in 
the  class  of  irritants,  its  use  as  an  antiseptic  claims  consideration  at  this 
place.  Obtained  usually  from  beechwood-tar  by  distillation,  creosote  is 
always  liquid,  nearly  colorless  when  fresh,  but  becoming  yellowish. 
The  U.  S.  P.  states  that  it  should  not  readily  become  brown  on  exposure 
to  light.  It  is  neutral  or  only  faintly  acid  to  litmus  paper.  It  is  soluble 
in  about  140  parts  of  water,  and  more  freely  in  absolute  alcohol,  ether, 
chloroform  and  oils.  In  some  respects  it  resembles  liquefied  phenol, 
but  the  latter  acquires  a  pink  or  reddish  color  with  exposure ;  in  odor  it 
is  somewhat  similar,  although  decidedly  smoky  and  unpleasant.  It  is 
less  useful  in  dental  practice,  because  of  its  odor  and  also  the  fact  that 
it  discolors  teeth  by  continuous  treatment.  The  chief  points  of  differ- 
ence between  the  two  substances  are  given  below^: 

Phenol.  Creosote. 

Crystallizable.  Always  liquid. 

A  definite  chemical  compound.  A  mixture  of  phenols. 

Coagulates  collodion.  Does  not  coagulate  collodion. 

Soluble  in  glycerin.  Insoluble  in  glycerin. 

Soluble  in  about  15  parts  of  water.  Soluble  in  about  140  parts  of  water. 

In  antiseptic  power  creosote  surpasses  phenol,*  and  its  internal  use 
is  safer.  In  recent  years  it  has  been  used  extensively  as  an  mternal 
remedy  in  the  treatment  of  pulmonary  tuberculosis,  tolerance  to  quite 
large  doses  being  readily  acquired.  It  has  a  local  analgesic  and  sedative 
effect,  which  makes  it  a  valuable  inhalant. 

In  full  strength  creosote  is  an  excellent  tooth  disinfectant,  being 
preferred  to  carbolic  acid  by  some,  because  it  has  little  or  no  coagulant 
action,  f  It  penetrates  more  deepty,  but  is  less  corrosive.  As  it  is 
apt  to  discolor  tooth  structure  it  is  not  to  be  used  in  teeth  that  are 
visible. 

As  a  mouth  wash  it  may  be  used  freely  in  saturated  aqueous  solution 
(0.66  per  cent.),  but  its  unpleasant  odor  and  taste  are  objectionable. 

*  See  table  on  p.  137. 

t  It  is  stated  by  some  authorities  that  creosote  contains  some  carbolic  acid  and  that 
it  coagulates  albumin.  This  was  formerly  true,  when  pure  creosote  was  difficult  to 
obtain  and  adulteration  with  carbolic  acid  was  common;  but  at  the  present  time 
pure  creosote  is  easily  obtainable  and  it  has  little  coagulant  action.  However, 
creosote  being  a*mixture  of  substances,  its  properties  may  vary  slightly. 


ALCOHOL  131 

The  official  aqua  creosoti  is  prepared  with  1  per  cent,  of  creosote,  in 
order  to  insure  saturation. 

Although  there  has  been  a  tendency  toward  eliminating  creosote 
from  dental  uses,  there  is  good  reason  to  believe  that  it  is  a  valuable 
antiseptic  agent  in  the  treatment  of  putrescent  root  canals.  On  the 
whole,  it  may  be  said  that  in  dental  practice  creosote  is  used  little 
compared  with  phenol,  though  a  stronger  antiseptic. 

Poisoning  by  this  drug  would  occur  by  SM^allowing  a  quantity  of  it 
pure.  The  symptoms  would  be  those  of  irritant  poisoning.  It  has  no 
definite  chemical  antidote.  Emetics  would  be  indicated,  followed  by 
demulcents. 

Creosoti  Carbonas. — Creosote  Carbonate. — A  liquid  mixture  of  car- 
bonates of  several  constituents  of  creosote,  chiefly  guaiacol  and  creosol. 
Average  dose,  TTl  15  (1  mil.).  This  agent,  being  a  mixture  of  sub- 
stances, varies  as  to  color,  odor  and  taste.  It  may  be  colorless,  odor- 
less and  tasteless,  or  it  may  be  yellowish  and  have  a  slight  odor  and 
taste  of  creosote.  It  is  insoluble  in  water,  but  soluble  in  alcohol  and 
in  fixed  oils.  It  is  less  irritating  for  internal  use  than  is  creosote  and, 
with  similar  uses  in  pulmonary  diseases,  it  can  be  given  in  larger  doses. 

Guaiacol  [C7H8O2].— Average  dose,  gr.  8  (0.5  gm.).— A  crystalline 
solid  obtained  from  creosote  and  constituting  from  60  to  90  per  cent. 
of  the  latter.  It  melts  at  82.4°  F.  It  is  soluble  in  53  parts  of  water, 
0.8  part  of  glycerin,  but  separating  upon  addition  of  water,  and  also 
soluble  in  alcohol  and  ether.  Being  a  definite  compound,  it  forms  a 
number  of  combinations,  some  of  which,  as  well  as  itself,  are  used  as 
substitutes  for  creosote  for  internal  administration.  Guaiacol  has  been 
used  as  a  vehicle  for  cocaine  in  its  application  by  cataplioresis. 

Guaiacolis  Carbonas.— Guaiacol  Carbonate  [(C7H70)2C03]. — Aver- 
age dose,  gr.  15  (1  gm.).  A  white  crystalline  powder,  insoluble  in  water, 
soluble  in  60  parts  of  alcohol,  neutral  and  almost  tasteless. 

Alcohol. — This  drug,  fully  considered  iti  other  places  as  astringent 
and  stimulant,  has  a  well-founded  reputation  as  an  antiseptic.  Its 
action  upon  bacteria  is  probably  due  to  its  power  of  abstracting  water 
and  of  coagulating  albumin.  It  is  less  valuable  as  a  disinfectant  than 
as  a  simple  antiseptic  and  as  a  vehicle  for  stronger  agents  of  this  class. 
It  must  be  used  in  strength  of  40  per  cent,  or  more  to  have  any  decided 
antiseptic  value;  however,  upon  the  dry  skin  the  very  strong  alcohol 
(absolute  and  95  per  cent.)  has  been  found  less  efficient  than  if  it  is 
diluted  somewhat.  This  is  due  to  the  hardening  effect  of  the  undiluted 
alcohol  which  hinders  penetration. 


132  ANTISEPTICS 

The  experiments  of  Harrington  and  Harris*  as  to  the  germicidal 
power  of  alcohol  in  different  strengths  led  to  the  following  results: 

1.  Against  dry  bacteria,  absolute  alcohol  and  ordinary  commercial 
alcohol  are  wholly  devoid  of  bactericidal  power,  even  with  twenty-four 
hours'  direct  contact;  and  other  preparations  of  alcohol  containing 
more  than  70  per  cent.,  by  volume,  are  weak  in  this  regard,  according 
to  their  content  of  alcohol ;  the  stronger  in  alcohol,  the  weaker  in  action. 

'2.  Against  the  commoner,  non-sporing,  pathogenic  bacteria  in  a 
moist  condition,  any  strength  of  alcohol  above  40  per  cent.,  by  volume, 
is  effective  within  five  minutes,  and  certain  preparations  within  one 
minute. 

3.  x\lcohol  of  less  than  40  per  cent,  strength  is  too  slow  in  action 
or  too  uncertain  in  results  against  pathogenic  bacteria,  whether  moist 
or  dry. 

"4.  The  most  effective  dilutions  of  alcohol  against  the  strongly, 
resisting  (non-sporing)  bacteria,  such  as  the  pus  organisms,  in  the  dry 
state,  are  those  containing  from  (K)  per  cent,  to  70  per  cent,  by  volume, 
which  strengths  are  equally  efficient  against  the  same  organisms  in  the 
moist  condition. 

"5.  Unless  the  bacterial  envelope  contains  a  certain  amount  of 
moisture,  it  is  impervious  to  strong  alcohol;  but  dried  bacteria,  when 
brought  into  contact  with  dilute  alcohol  containing  from  30  per  cent. . 
to  60  per  cent,  of  water  by  volume,  will  absorb  the  necessary  amount 
of  water  therefrom  very  quickly,  and  then  the  alcohol  itself  can  reach 
the  cell  protoplasm  and  destroy  it. 

'6.  The  stronger  preparations  of  alcohol  possess  no  advantage  over 
the  60  per  cent,  to  70  per  cent,  preparations,  even  when  the  bacteria 
are  moist;  therefore,  and  since  they  are  inert  against  dry  bacteria,  they 
should  not  be  employed  at  all  as  a  means  of  securing  an  aseptic  condi- 
tion of  the  skin." 

Certain  of  the  vegetable  tinctures  have  a  reputation  as  antiseptics, 
which  with  a  few  is  well-founded.  When  we  consider  the  value  of  the 
contained  alcohol,  it  appears  that  any  addition  of  a  drug  that  has 
antiseptic  power  should  produce  a  valuable  preparation. 

Tinctura  Myrrhae. — Tincture  of  Myrrh. — Average  doscTH.  15  (1  mil.). 
— This  has  long  been  used  as  an  application  to  the  gums,  and  as  an 
ingredient  in  mouth  washes.  To  irritated,  lacerated  or  spongy  gums, 
ulcers,  etc.,  it  may  be  applied  freely.     It  cannot  be  diluted  with  water, 

*  Boston  Medical  and  Surgical  Journal,  May  21,  1903. 


TINCTURA  BENZOINI  COMPOSITA  133 

for  the  latter  precipitates  the  resinous  portion  of  myrrh.  It  can  only 
be  mixed  with  water  or  aqueous  solutions  in  the  presence  of  a  large  per- 
centage of  alcohol.  A  dilution  of  alcohol  with  more  than  one-third 
water  will  not  mix  with  tincture  of  myrrh  without  precipitation 
occurring. 

Tinctura  Benzoini. — Tincture  of  Benzoin  (20  per  cent.). — ^Average 
dose,  m  15  (1  mil.) 

Tinctura  Benzoini  Composita.* — Compoixnd  Tincture  of  Benzoin 
(10  per  cent,  benzoin).     Average  dose,  TU  30  (2  mils.). 

Benzoin  contains  resin,  benzoic  acid  (about  14  per  cent.)  and  traces  of 
a  volatile  oil.  Benzoic  acid  has  been  found,  by  a  number  of  observers, 
to  rank  among  our  very  best  non-irritating  antiseptics,  and  it  is  freely 
soluble  in  alcohol;  therefore,  these  tinctures  should  be  valuable  anti- 
septics, as  they  contain  1  to  4  per  cent,  of  benzoic  and  cinnamic  acids, 
the  latter  being  also  valuable. 

The  compound  tincture  is  a  time-honored  preparation,  and  one  of 
the  best  antiseptic  and  stimulant  applications  to  mucous  membranes. 
An  unhealthy  or  ulcerated  condition  of  the  gums  calls  for  its  use.  It 
must  be  applied  upon  cotton.  It  cannot  be  used  in  a  mouth  wash 
because  of  the  precipitation  of  the  resin  when  mixed  with  water.  Except 
the  resinous  portion,  it  may  be  vaporized  with  steam  by  being  poured 
upon  boiling  water,  and  it  thus  forms  a  useful  inhalant  in  irritable  or 
infected  conditions  of  the  upper  air  passages.  A  useful  prescription 
for  this  purpose  is  the  following: 

Gm.  or  mil. 

I^ — Phenolis  liquefacti 10  (fSijss 

Spiritus  camphorae 10  (fSijss) 

Tincturse  benzoini  compositse      ....     30  (f§j) 

Glycerini q.  s.  ad    60  (fgij)— M. 

Sig. — A  teaspoonful  to  a  pint  of  boiling  water.     Inhale  the  steam. 

For  the  correction  of  foul  breath,  when  due  to  an  unhealthy  con- 
dition of  tonsils  or  upper  air  passages,  the  same  inhalation  is  useful;  in 
addition  the  compound  tincture  may  be  applied  in  full  strength  to  the 
surface  of  the  tonsil  and  within  all  of  its  crypts  that  are  visible.  Foul 
breath  may  be  due  to  the  collection  of  solid  offensive  secretion  within 
these  crypts.     This  should  be  removed  before  making  the  application. 

*  The  formula  of  compound  tincture  of  benzoin  contains: 

Benzoin 100  parts 

Purified  aloes 20     " 

Storax 80     " 

Balsam  of  tolu 40     " 

Alcohol,  to  make 1000     " 


134  ANTISEPTICS 

Balsamum  Peruvianum. — Balsam  of  Peru. — ^A  balsam  obtained  from 
Toluifcra  Percircp. — It  is  a  thick,  dark  brown  liquid,  having  an  agree- 
able odor  resembling  that  of  vanilla.  It  is  soluble  in  alcohol  and  in 
chloroform,  partly  soluble  in  ether  and  almost  insoluble  in  water.  Its 
value  as  an  antiseptic  depends  upon  benzoic  and  cinnamic  acids  and 
aromatics  which  it  contains.  It  is  rarely  used  internally,  but  is  an 
agreeable  and  valuable  application  to  ulcers  and  in  parasitic  diseases 
of  the  skin. 

Acidum  Benzoicum. — Benzoic  Acid  [C7H6O2]. — Average  dose,  gr.  8 
(0.5  gm.).  An  organic  acid  obtained  from  benzoin,  or  prepared  arti- 
ficially. This  drug  occurs  in  whitish  crystals,  with  or  without  the 
odor  of  benzoin,*  has  a  pungent  taste  and  is  somewhat  volatile.  It  is 
soluble  in  275  parts  of  water,  but  with  an  equal  quantity  of  borax  it  is 
soluble  in  100  parts  of  water;  soluble  also  in  2.3  parts  of  alcohol  and 
in  10  parts  of  glycerin.  It  has  an  acid  reaction.  A  solution  of  1  to 
400  has  been  found  to  destroy  developed  bacteria;  and  according  to 
Miller,  a  1  per  cent,  solution  will  accomplish  ordinary  disinfection  of 
the  mouth  in  one-quarter  of  a  minute.  With  its  solubility  in  water 
increased  by  borax,  the  two  may  be  combined  in  aqueous  solution  to 
make  a  very  efficient  mouth  wash.  It  is  found  that  a  saturated  solu- 
tion of  borax  will  dissolve  1  per  cent,  or  more  of  benzoic  acid  and  still 
be  alkaline. 

Incompatihiliiy. — When  a  solution  of  benzoic  acid  has  been  neutral- 
ized by  an  alkali,  as  with  borax,  a  precipitate  will  occur  when  mixed 
with  hydrochloric  or  dilute  nitric  acid,  or  with  dilute  solutions  oi  ferric 
salts  or  with  lead  acetate,  mercuric  chloride  or  silver  nitrate. 

Acidum  Salicylicum. — Salicylic  Acid  [CyHeOs]. — Average  dose,  gr.  12 
(0.75  gm.).  An  organic  acid  obtained  from  vegetable  sources  or  pre- 
pared from  carbolic  acid.  It  occurs  in  very  fine,  white  needles  or  crys- 
talline powder,  having  a  sweetish  taste.  It  is  soluble  in  4G0  parts  of 
water  and  in  2.7  parts  of  alcohol,  2  parts  of  olive  oil  and  00  parts  of 
glycerin.  It  is  acid  in  reaction.  According  to  Miller,  f  a  1  per  cent, 
solution  will  accomplish  ordinary  disinfection  of  the  mouth  in  one- 
quarter  of  a  minute.  It  must  be  ranked  among  our  best  antiseptics, 
but  it  is  objectionable  for  continued  use  because  of  its  acid  reaction. 
The  saturated  aqueous  solution  is  rather  weak  to  be  of  much  value  as 

*  Benzoic  acid  prepared  artificially  does  not  have  the  odor  of  l)enzoin. 
t  Microorganisms  of  the  Human  Mouth. 


PHENYLIS  SALICYLAS  135 

a  disinfectant;  but  a  saturated  solution  of  borax  in  water  will  dissolve 
1  per  cent,  or  more  of  salicylic  acid  and  still  be  alkaline  in  reaction. 
Such  a  solution  really  makes  an  ideal  mouth  wash.  The  drug  may  also 
be  used  as  a  mouth  wash  either  in  combination  with  other  antiseptics 
or  in  alcoholic  solution  diluted. 

Incompatibility. — ^^Vith  'potassium  chlorate,  hydrochloric  acid,  nitric 
acid,  chlorine  or  a  solution  of  ferric  chloride,  it  undergoes  chemical 
change.  It  causes  gradual  decolorization  of  a  solution  of  potassium 
permanganate.  With  carbonates  it  effervesces,  with  the  formation  of 
salicylates. 

Sodii  Salicylas. — Salicylate  of  Soditoi  [XaC7H503]. — ^Average  dose, 
gr.  15  (1  gm.).  This  salt  is  much  more  soluble  in  water  than  is  the  acid, 
being  soluble  in  0.9  part,  also  in  9.2  parts  of  alcohol  and  in  glycerin. 
For  internal  use  it  is  less  disturbing  to  the  stomach  than  salicylic  acid, 
and  it  is  used  largely  in  the  acute  stage  of  rheumatism  to  control  the 
fever  and  pain.     It  is  not  a  very  efficient  antiseptic. 

Phenylis  S-alicylas. — Salol  [C13H10O3]. — Average  dose,  gr.  5  (0.3  gm.) 
It  occurs  in  form  of  a  white,  crystalline  powder,  having  a  sweetish  taste, 
almost  msoluble  in  water,  soluble  in  6  parts  of  alcohol,  and  in  ether, 
chloroform  and  oils.  It  melts  at  42°  C.  (107.6°  F.).  Its  use  in  dentistry 
depends  upon  the  ease  with  which  it  can  be  fused,  and  the  fact  that, 
when  fused  at  a  tetnperature  considerably  above  its  melting-pomt, 
recrystallization  is  retarded.  Mascort*  in  1894  advocated  its  use  in 
melted  form  as  a  root-canal  filling.  Being  a  feeble  antiseptic  unless 
decomposed,  its  ready  adaptability  and  non-hritating  character  must 
be  its  chief  recommendations.  It  is  used  either  alone  or  in  connection 
with  a  cone  of  gutta-percha.  This  substance  is  not  often  employed 
as  a  local  antiseptic,  because  of  its  insolubility  in  water.  It  may, 
however,  be  used  in  alcoholic  solution.  Its  chief  use  is  as  an  intestinal 
antiseptic.  Its  adaptability  to  this  use  lies  in  the  fact  that,  passing 
through  the  stomach  unchanged,  it  is  first  decomposed  into  carbolic 
and  salicylic  acids  by  contact  with  the  alkaline  juices  in  the  small 
intestine,  where  the  effect  of  these  tw^o  antiseptic  substances  is  then 
obtained.  It  is  valuable  in  diarrheas  and  intestinal  fermentation,  but 
with  large  doses  toxic  effects  of  phenol  are  possible. 

*  Dental  Cosmos,  1894,  p.  352. 


136  ANTISEPTICS 

VOLATILE   OIL   GROUP. 

Volatile  oils  are  odorous,  volatile  principles,  not  possessing  the  chemi- 
cal qualities  of  true  oils.  Since  they  are  mostly  obtained  by  distillation 
they  are  also  called  distilled  oils;  and,  as  they  are  usually  the  most 
essential  constituent  of  the  drug  yielding  them,  they  are  also  known  as 
essential  oils.  While  usually  of  vegetable  origin,  several  are  now  made 
synthetically. 

^"olatile  oils  are  colorless  or  nearly  so  when  freshly  distilled,  becom- 
ing, as  a  class,  somewhat  colored  wdth  age  and  exposure,  without  losing 
any  of  their  valuable  properties.  They  are  insoluble  in  water,  soluble 
in  alcohol,  ether,  chloroform  and  fixed  oils.  The  volatile  oils  as  a  class 
are  antiseptics.  Some  have  an  analgesic  effect  when  applied  to  sensitive 
tissue,  while  others  are  irritating  and  a  few  are  poisonous.  Some  are 
not  applicable  to  uses  about  the  mouth  because  of  unpleasant  taste 
or  odor.  Most  of  them  are  used  in  full  strength  as  disinfectants  in 
root  canals  and  in  carious  cavities,  but  by  prolonged  use  they  may 
discolor  the  tooth  structure. 

Even  with  pulp  exposure  the  non-irritating  oils  may  be  used.  They 
do  not  destroy  tissue,  they  do  not  coagulate  albumin,  hence  they  pene- 
trate well,  and  any  irritation  from  brief  application  is  but  slight  and 
momentary.  Exception  to  the  last  statement  is  found  with  oils  of 
turpentine  and  mustard,  but  these  are  seldom  used  in  the  mouth  because 
of  their  rank  odor. 

Dr.  A.  H.  Peck*  has  contributed  some  excellent  experimental  work 
with  the  volatile  oils  and  a  few  other  antiseptics,  in  which  he  studied 
their  antiseptic  power,  their  action  upon  soft  tissues,  their  influence 
upon  the  healing  of  sores  and  their  germicidal  action  upon  infected 
sores.  He  very  properly  holds  that .  the  volatile  oils  and  other  agents 
have  been  used  "without  reference  to  their  relative  merits  as  anti- 
septics, or  to  their  therapeutic  effects  upon  the  tissues  to  which  they  are 
applied." 

From  these  observations,  a  summary  of  which  is  given  in  the  table 
following,  he  concludes  that  the  oils  of  cinnamon  (including  oil  of 
cassia),  while  high  in  antiseptic  value,  are  too  irritating  to  be  used  in 
root  canals.  Also  that  oil  of  cloves  and  creosote  are  superior  agents, 
both  being  efficient  antiseptics,  while  non-irritating  to  soft  tissues. 
In  fact,  he  found  oil  of  cloves  to  possess  local  analgesic  properties  to  a 

*  The  Dental  Review,  August,  1898,  p.  593. 


VOLATILE  OIL  GROUP 


13/ 


marked  degree.     He  regards  oil  of  gaultheria  as  useless.     Formalin  he 
discards  in  the  treatment  of  conditions  about  the  mouth. 

Attention  is  asked  to  the  comparative  table  below,  following  which 
the  several  volatile  oils  are  described  separately: 

Antiseptic  Power  and  Local  Action  of  Certain  Volatile  Oils  and  Other 
Substances  (Dr.  A.  H.  Peck).* 
Antiseptic  Power.  Action  on  Soft  Tissues. 

10  c.c.  of  sterile  mutton  bouil- 
lon as  culture  medium.  Growth  TVTien    confined    to        When    sprayed 
of  mouth  bacteria  prevented  by  skin  by  rubber  cap.         upon  artificial  sore 
amounts  given  below  in  drops.  (guinea-pig). 
(Ratio  varies  as  size  of  drop.)       Ratio. 

Oil  of  cassia 0.3  drop,    or  1:2233     24   hrs.      Blister;    in-    Healing  prevented. 

tense  inflammation 
Oil  of  cinnamon  with  slow  heaHng. 

(Ceylon) 0.3      "  1:2100     24  hrs.      Blister;   less    Healing  prevented. 

Oil  of  cinnamon  severe  than  above. 

(synthetic) 0.3      "  1:2133     15  hrs.     Blister;  but 

Creosote  (beech-  no  inflammation. 

wood) 0.5      "  1 :  1280     36  hrs.    No  irritation.     Sore  healed. 

Oil  of  cloves 0.6      "  1:1150     36  hrs.    No  irritation.     Rapid  healing. 

Oil  of  bay 0.7      "  1 :  1028     36  hrs.    No  irritation.     Inflammation  sub- 

sided gradually. 
Oil  of  sassafras..  .  .0.7      "  1:1000     36  hrs.    No  irritation.     Inflammation  sub- 

sided. 
Oil  of  peppermint  .0.8      "  1 :  875       36  hrs.    No  irritation.     Inflammation  sub- 

sided. 
Black's  "1-2-3"  f.  .1.4  drops,  or  1:454       36  hrs.    No  irritation.     Inflammation  sub- 
sided. 
Phenol  (959^)....  1.8      "  l:338t 

Oil  of  cajuput ....  6  "  1 :  120       36  hrs.    No  irritation.     No  irritation. 

Eucalyptol  (San- 
der's and  Merck's  6       "  1:116       36  hrs.    No  irritation.      Inflammation  sub- 
Eucalyptol  sided. 

(ordinary) Saturated      solution 

required. 

„.,    .        ixi_     ■      f  No    action    even    in 
Oil  of  gaultheria.     •       ,  i      i     . 

T^  ,  i      saturated  solution 

^^S^°°^ I      (8  drops). 

Formalin 0.4  drop,    or  1 :  1400       4  hrs.     Severe  pain. 

20  hrs.     Severe  inflammation,  followed  by 

sloughing  and  toxic  symptoms. 

Germicidal  Action.     Apphed  to  infected  sores,  ]pus  germs  were  destroyed  by 

the  cinnamon  oils,  creosote,  oil  of  cloves,  oil  of  bay,  oil  of  peppermint  and  Black's 

"1-2-3."    Oil  of  sassafras  was  less  efficient,  while  the  action  of  oil  of  cajuput  and 

eucalyptol  was  not  very  positive. 

*  For  article  forming  basis  of  this  summary,  see  Dental  Review,  August,  1898. 
t  Black's  "1-2-3"  mixture  (mild)  consists  of  1  part  oil  of  cassia,  2  parts  phenol 
(crystals),  and  3  parts  oil  of  gaultheria. 

X  The  influence  of  phenol  was  transient,  growth  occurring  after  three  days. 


13S  ANTISEPTICS 

Oleum  Cassias. — Oil  of  Cinxamox. — Oil  of  Cassia. — ^Average  dose, 
TU  3  (0.2  mil.).  A  volatile  oil  distilled  from  Cassia  cimiamoii  (young 
twigs),  containing  not  less  than  80  per  cent,  of  cinnamic  aldehyde,  and 
ha^■ing  the  odor  and  taste  of  cinnamon.  It  is  yellowish  or  brownish 
in  color,  becoming  darker  and  thicker  by  age  and  exposure;  sp.  gr. 
about  1.055;  soluble  in  about  3  parts  of  70  per  cent,  alcohol.  The 
changes  by  age  are  due  to  the  oxidation  of  cinnamic  aldehyde  to  cin- 
namic acid  and  resins;  therefore,  the  oil  should  be  kept  from  exposure 
to  light  and  air  m  well-stoppered,  amber-colored  bottles,  in  a  cool  place. 
The  oil  is  frequently  adulterated.* 

Oil  of  cinnamon  is  non-coaguknit  to  tissues,  it  is  penetrating,  it  is 
agreeable  in  odor  and  the  discomfort  of  its  application  to  soft  tissues 
is  momentar}^,  unless  it  is  confined  for  some  time,  when  it  may  cause 
severe  irritation.  It  is  doubtless  the  most  powerful  antiseptic  of  all 
the  volatile  oils  used  hi  dentistry  (see  preceding  table).  It  is  used  for 
tooth  dismfection,  but  is  less  applicable  to  front  teeth  than  to  posterior 
ones,  because  of  its  discoloring  effect  with  continued  use,  this  being 
due  to  its  tendency  to  become  darker  with  exposure.  It  may  be  used 
in  full  strength  in  pyorrhea  with  deep  pockets. 

Aquae  Cinnamomi. — Cixxamox  Water. — Average  dose,  f5  4  (15 mils.). 
Cinnamon  water  is  officially  prepared  as  follows : 

Gm.  or  mils. 

I^ — Olei  cassiae 2 

Talci  purificati 15 

Aquse  destillatse q.  s.  ad     1000 

Triturate  the  oil  with  the  purified  talc,  add  the  recentlj^  boiled  distilled  water 
gradually  with  continued  trituration,  filter,  and  pass  the  filtrate  through  the  filter 
repeatedly  until  the  cinnamon  water  is  perfectly  clear.  (It  is  estimated  that  one- 
half  of  the  oil  is  dissolved  by  the  water.) 

Spirihfs  Cinnamomi  (10  per  cent.)  is  also  official.  Average  dose,  TU  30 
(2  mils.). 

The  official  cinnamon  water  is  useful  as  a  mouth  wash  and  to  irrigate 
fistulous  tracts,  as,  according  to  Dr.  Peck's  report,  it  should  be  able  to 
prevent  the  growth  of  mouth  bacteria.  It  is  very  pleasant  to  the  taste 
and  can  well  be  used  in  preference  to  proprietary  liquids  of  complex 
composition  and  imcertain  value.     It  may  be  used  in  full  strength  freely. 

Oil  of  cinnamon  is  an  important  ingredient  in  the  formula  of  Dr. 

*  Oil  of  cassia  has  often  been  found  adulterated  with  a  mixture  of  petroleum  and 
rosin.  The  U.  S.  P.  test  for  detection  is  as  follows:  Shake  2  mils,  of  the  oil  in  a  test- 
tube  with  from  5  to  10  mils,  of  purified  benzin,  and  decant  the  latter;  this  hquid  is 
colorless  and  does  not  assume  a  green  color  upon  shaking  it  with  an  equal  volume  of 
y\f  per  cent,  copper  acetate  solution. 


VOLATILE  OIL  GROUP  139 

Black,  known  as  Black's  1-2-3,  which  is  widely  used  as  a  dressing  in 
pulp  canals  where  antiseptic  and  anodyne  action  is  needed.  The 
formula  is  as  follows : 

Gm.  or  mils. 

'Bf. — Olei  cassise 4 

Phenolis  fcrv'stals) 81 

Olei  gaultherise 12) 

Mix  the  oils  and  add  the  melted  crj^staLs  of  phenol. 

Cixxa:mic  Aldehyde  [CgHjO]  (not  official;. — An  aldehyde  obtained 
from  oil  of  cinnamon  or  prepared  synthetically.  It  should  be  95  per 
cent,  in  strength.  It  is  nearly  identical  with  the  official  oil  of  cinna- 
mon, having  the  same  qualities  in  general,  but  being  more  definite  in 
composition.  At  a  low  temperature  it  becomes  solid,  melting  again  at 
18.5°  F.  It  is  sparingly  soluble  in  water,  but  soluble  in  alcohol,  ether 
and  oils.     It  uses  are  the  same  as  those  of  oil  of  cinnamon. 

Oleum  Caryophylli.— Oil  of  Cloves. — ^Ai-erage  dose,  TU  3  (0.2  mil.j. 
A  volatile  oil  distilled  from  cloves  (the  flower-buds  of  Eugenia  Aromatica) , 
varying  in  color  from  pale  yellow  to  brown,  age  and  exposure  producing 
the  change.  It  has  the  odor  and  taste  of  cloves,  is  soluble  in  2  parts 
of  70  per  cent,  alcohol,  the  resulting  solution  ha\dng  a  slightly  acid 
reaction.  Sp.  gr.  about  1.050.  Its  chief  constittient  of  value  is  eiigenol, 
of  which  it  should  contain  82  per  cent. 

While  the  change  m  color  does  not  impair  its  value,  it  should  be  kept 
protected  from  light  and  air,  so  as  to  retard  the  same. 

Oil  of  cloves  has  a  high  antiseptic  value  (1  to  1150  for  mouth  bac- 
teria), while  Dr.  Peck's  experiments  have  proved  positively  that  it  is 
not  only  non-irritating  locally,  but  that,  when  applied  to  inflamed  or 
infected  tissues,  it  is  decidedly  soothing,  and  healing  progresses  rapidly 
under  its  application.     It  is  iwn-coagidant  to  tissue. 

It  can  be  used  freely  as  a  tooth  and  root  canal  disinfectant,  though  its 
tendency  to  discolor  prohibits  its  use  in  front  teeth.  It  is  entitled  to  a 
larger  use  as  an  application  to  irritated  and  infected  tissues.  In  addi- 
tion to  its  dental  uses,  oil  of  clo\'es  is  employed  in  the  preparation  of 
microscopic  specimens. 

Eugenol  [C10H12O2]. — ^Average  dose  TU  3  fO.2  mil.).  An  aromatic 
phenol,  the  chief  constituent  of  oil  of  cloves,  but  obtainable  also  from 
other  sources.  Sp.  gr.  about  1.067.  It  is  similar  to  oil  of  cloves  in 
all  of  its  qualities.  It  may  be  mixed  with  alcohol  in  any  proportion 
and  it  is  soluble  in  2  parts  of  70  per  cent,  alcohol.  In  Peck's  observa- 
tions it  was  found  to  be  much  inferior  to  oil  of  cloves  {vide  ante). 


140  ANTISEPTICS 

The  two  following  agents  are  ^'ery  similar,  both  owing  their  ^•alue 
chiefly  to  cineol  (identical  with  cajuputol  and  eucalyptol) . 

Oleum  Cajuputi.— Oil  of  Cajuput. — Average  dose,  TTl  8  (0.5  mil.).  A 
volatile  oil  obtained  from  the  fresh  leaves  and  twigs  of  Melaleuca  leuca- 
dendron.  Its  chief  constituent  is  cineol  (eiicalyptol) ,  of  which  there 
should  be  at  least  55  per  cent. 

It  is  a  light,  thin,  colorless  liquid,  with  an  aromatic  odor  and  taste. 
It  is  soluble  in  1  part  of  80  per  cent,  alcohol,  the  solution  being  neutral. 
Sp.  gr.  about  0.920. 

Oleum  Eucalypti. — Oil  of  Eucalyptus. — Average  dose,  TTl  8  (0.5 
mil.).  Distilled  from  the  fresh  leaves  of  Eucalyjitiis  globulus,  this  vola- 
tile oil  owes  its  value  to  cineol  (eucalyptol),  of  which  it  should  contain 
70  per  cent.  It  is  soluble  in  4  parts  of  70  per  cent,  alcohol,  the  solution 
being  neutral.     Sp.  gr.  about  0.915. 

It  is  similar  to  oil  of  cajuput  because  of  the  presence  of  cineol.  It  has 
no  distinct  value  in  comparison  with  other  volatile  oils,  and  preference  is 
usually  given  to  the  following  chief  constituent,  which  is  more  definite 
than  the  oil. 

Eucalyptol. — Cineol. — Cajuputol  [CioHigO]. — Average  dose  TTl  5 
(0.3  mil.).  An  organic  compound  obtained  from  oil  of  eucalyptus  and 
other  sources.  It  is  a  colorless  liquid  with  an  aromatic,  camphoraceous 
odor  and  a  spicy,  cooling  taste.  It  is  soluble  in  alcohol  in  any  propor- 
tion, the  solution  being  neutral.  Sp.  gr.  0.922.  It  should  be  kept 
protected  from  air  and  light. 

Eucalyptol  has  no  special  advantage  over  the  stronger  volatile  oils, 
though  regarded  by  some  as  especially  detergent  in  root  canals.  It  is 
non-irritating  and  non-coagulant.  Its  antiseptic  value  is  shown  in  the 
table  on  p.  137. 

Oleum  Gaultherise. — Oil  of  Wintergreen. — [Known  now  officially 
as  Methylis  Salicylas. — Methyl  Salicylate]  [CH3C7H5O3]. — Average 
dose,  TTl  12  (0.75  mil.).  This  volatile  oil  is  produced  synthetically  or 
distilled  from  Gautheria  procumbens.  From  either  source,  it  has  the 
odor  and  taste  of  wintergreen.  It  is  used  chiefly  as  a  flavoring  agent 
Its  antiseptic  value  is  low. 

Thymol  [C10II14O]. — A  phenol,  present  m  the  volatile  oil  of  Thymus 
vulgaris  and  some  other  volatile  oils.  Dose,  gr.  1-30  (0.06-2  gm.).  It 
occurs  in  large,  colorless  crystals,  having  a  penetrating  odor  of  thyme 
and  an  aromatic  taste,  soluble  in  1010  parts  of  water,  in  about  1  part  of 
alcohol,  also  soluble  in  chloroform,  ether  and  oils.  It  is  used  as  a  general 
antiseptic,  having  a  germicidal  power  similar  to  that  of  phenol,  as  a 


VOLATILE  OIL  GROUP  141 

substitute  for  which  it  was  introduced  into  medicine.  It  is  less  toxic 
than  phenol.  It  is  used  also  as  an  anthelmintic,  being  regarded  almost 
a  specific  in  hook-worm  disease  (uncinariasis)  where  it  is  given  in  the 
large  dosage  of  from  1  to  2  gms.  per  day. 

Thymolis  lodidum. — Thymol  Iodide  [C2rjH2402l2] ■ — This  substance, 
known  also  as  Aristol,  contains  43  per  cent,  of  iodine.  It  is  a  reddish- 
yellow  or  brownish  powder,  insoluble  in  water  and  glycerin,  very 
slightly  soluble  in  alcohol,  freely  soluble  in  ether  and  in  oils.  It  does  not 
keep  well  unless  protected  from  light.  It  is  used  as  an  antiseptic  powder, 
and  is  applicable  as  a  pulp-canal  dressing. 

Oleum  Menthse  Piperitse.— Oil  of  Peppermint. — ^Average  dose,  TH  3 
(0.2  mil. J.  A  volatile  oil  distilled  from  the  flowering  plant  of  Mentha 
piperita,  yielding  50  per  cent,  of  total  menthol  (5  per  cent,  as  esters). 
It  is  colorless,  neutral  and  soluble  in  4  parts  of  70  per  cent,  alcohol.  It 
should  be  kept  in  a  cool  place  and  protected  from  light.  It  possesses 
a  strong  odor  of  peppermint.  Its  contact  with  tissue  is  followed  by  a 
sensation  of  cold.  In  form  of  the  spirit  (10  per  cent.)  it  is  given  inter- 
nally as  a  carminative.  Locally  it  is  analgesic  and  antiseptic,  and  is, 
therefore,  useful  to  relieve  itching  of  skin  or  mucous  membrane,  a  5  to 
10  per  cent,  ointment  or  solution  in  alcohol  being  used. 

Menthol  [C10H19OH]. — ^Average  dose,  gr.  1  (0.06  gm.).  A  secondary 
alcohol  obtained  from  oil  of  peppermint  or  other  mint  oils.  It  occurs  in 
colorless  crystals  having  the  characteristic  odor  of  peppermint.  It  is 
only  slightly  soluble  in  water,  freely  soluble  in  alcohol,  ether,  chloroform 
and  oils.  When  rubbed  upon  the  skin  there  follows  a  decided  sensation 
of  cold  to  the  part.  This  effect  classes  it  as  an  analgesic  and  makes  it 
a  valuable  application  in  itching  (pruritus)  of  various  parts.  It  may 
be  applied  in  solution  or  in  ointment. 

It  is  a  useful  antiseptic  for  internal  administration  and  for  local 
dental  uses.  As  an  analgesic  antiseptic  for  use  in  pulp  treatment  it 
may  be  dissolved  in  chloroform  or  in  a  volatile  oil.  In  neuralgias  and 
headaches  the  solid  crystal  is  rubbed  upon  the  skin  of  the  painful  area. 

Oleum  Terebinthinee  Rectificatum.— Rectified  Oil  of  TrRPEXTiXE. — ■ 
Average  dose,  TU  5  (0.3  mil.).  This  agent  has  been  discussed  in  its  more 
important  use  as  an  irritant.  As  an  antiseptic  it  is  chiefly  used  exter- 
nally to  disinfect  the  skin  or  the  hands  of  the  operator  in  preparation  for 
surgical  operations. 

Terebenum. — Terebene. — Average  dose,  1TL  4  (0.25  mil.).  The  reac- 
tion between  oil  of  turpentine  and  sulphuric  acid  yields  a  colorless 
liquid,  known  as  terebene.     It  has  an  agreeable  odor  and  aromatic 


142  ANTISEPTICS 

taste,  and  it  should  rank  among  the  vahiable  antiseptics  for  local  use. 
It  is  almost  insoluble  in  water,  but  is  soluble  in  3  parts  of  alcohol.  With 
exposure  to  light  and  air  it  gradually  becomes  resinified  and  acquires  an 
acid  reaction.     It  is  used  internally  in  bronchitis. 


HALOGEN    GROUP. 

Bromum, — ^Bromine  [Br]. — Besides  its  use  as  an  escharotic,  bromine 
in  aqueous  solution  (soluble  in  90  parts)  is  a  good  general  disinfectant, 
but  its  irritating  vapor  precludes  its  use  about  the  mouth  or  air  passages. 

Chlorine  [CI]. — (For  internal  doses,  see  Index  of  Drugs.)  Pure  chlo- 
rine in  gaseous  form  is  too  irritating  and  poisonous  to  be  employed  except 
to  disinfect  rooms.  One  part  in  100  of  the  atmosphere,  with  moisture 
present,  is  an  efficient  germicide  for  disinfection  of  dwellings.  In 
either  of  the  official  preparations  it  is  available  for  tooth  disinfection  or 
bleachmg.  It  is  also  a  deodorant  by  its  power  of  decomposing  sul- 
phuretted hydrogen  compounds.  Its  disagreeable  odor  is  an  objection 
to  its  use  as  a  mouth-wash,  but  it  is  a  very  efficient  antiseptic.  Even 
1  part  in  22,000  has  been  found  capable  of  killing  developed  bacteria.* 

The  value  of  chlorine  as  a  water  disinfectant  has  led  to  the  method 
of  "chlorination"  upon  a  large  scale  in  order  to  insure  a  safe  water 
supply  to  cities.  In  the  experience  of  the  city  of  London  it  has  been 
found  that  1  part  of  chlorine  to  2,000,000  parts  of  water  is  efficient, 
while  1  part  in  even  3,000,000  has  given  considerable  success. f 

Following  are  the  commonly  used  chlorine  disinfectants: 

Liquor  Sodce  ChlorinatcB  (Labarraque's  solution)  contains  at  least  2.5 
per  cent,  of  available  chlorine. 

Calx  Chlorinata  (Chlorinated  lime,  Bleaching  powder)  contains  at 
least  30  per  cent,  of  available  chlorine. 

Incompatibility. — Chlorine  gas  with  a  solution  of  ammonium  chloride 
forms  chloride  of  nitrogen,  which  is  explosive.  Chlorine  water  decom- 
poses potassium  iodide  in  solution,  liberating  iodine,  and  mked  with 
a  solution  of  silver  nitrate  it  precipitates  chloride  of  silver.  In  contact 
with  silver  cyanide  it  liberates  hydrocyanic  acid.  It  oxidizes  organic 
substances  and  destroys  vegetable  colors.  Liquor  sodse  chlorinatse  is 
decomposed  by  hydrochloric  acid  with  evolution  of  chlorine  gas  and 
carbon  dioxide. 

*  Brunton's  Pharmacology,  1885,  p.  96. 

t  Houston:  Water  and  Gas  Review,  NeW  York,  May,  1919. 


HALOGEN  GROUP  143 

lodum. — Iodine  [I]. — This  substance  ranks  with  the  other  halogens 
as  a  powerful  antiseptic.  The  tincture  can  be  added  to  water  to  secure 
any  desired  strength,  a  weak  solution  being  suitable  as  an  irrigation  to 
pus  cavities.  As  an  inhalant  in  pulroonary  diseases,  when  a  powerful 
antiseptic  vapor  is  needed,  the  tincture  may  be  vaporized  with  steam 
in  a  strength  not  to  exceed  10  minims  (0.6  gm.)  to  a  pint  of  boiling 
water,  usually  combined  with  carbolic  acid,  eucalyptol  or  similar  drugs. 
In  its  uses  it  has  been  considered  under  Irritants. 

lodoformum. — Iodoform  [CIII3]. — Obtained  by  the  action  of  iodine 
upon  alcohol  in  the  presence  of  an  alkali,  it  is  in  form  of  a  lemon-yellow 
crystalline  powder,  with  a  xexy  penetrating  odor  resembling  that  of 
iodine.  It  is  practically  insoluble  in  water,  soluble  in  60  parts  of  alco- 
hol and  in  7.5  parts  of  ether.  It  contains  96.7  per  cent,  of  iodine,  to 
which  its  antiseptic  power  has  been  supposed  to  be  due.  However, 
Heile*  found  that  the  value  of  iodoform  does  not  depend  upon  nascent 
iodine,  but  upon  a  much  more  active  substance,  diiodacetylidin,  which 
is  set  free  from  iodoform  in  contact  with  organic  substances  when  air 
is  excluded  Iodoform  differs  from  iodine  in  being  non-irritant.  As  an 
antiseptic  dressing  it  is  applied  in  powder,  or  upon  gauze,  to  wounds 
and  ulcers.  Its  disagreeable  odor  precludes  its  use  in  dentistry;  but  a 
number  of  odorless  or  less  unpleasant  substitutes  have  been  introduced, 
examples  of  which  are  here  named,  the  first  only  being  official.  They 
are  all  nearly  insoluble  in  water. 

Thymol  Iodide  (Aristol),  containmg  43  per  cent,  of  iodine. 

lodol  containing  89  per  cent,  of  iodine. 

Antiseptol,  containing  50  per  cent,  of  iodine. 

Losophane,  containing  78  per  cent,  of  iodine. 

Sozoiodol  (Sozoiodolic  acid),  containing  54  per  cent,  of  iodine,  20 
per  cent,  carbolic  acid,  and  7  per  cent,  sulphur.  This  substance  has 
acid  combining  properties  and  forms  a  number  of  salts.  Sodium  sozo- 
iodolate  is  preferred  on  account  of  its  ready  solubility  in  water  and' 
in  glycerin. 

In  addition  to  the  above  group,  the  following  substance,  derived  from 
coal-tar,  holds  a  place  as  an  antiseptic  powder: 

Acetanilidum  [CsHgNO]. — ^Acetanilid,  a  white  crystalline  substance, 
obtained  by  the  interaction  of  glacial  acetic  acid  and  aniline,  is  employed 
in  very  fine  powder,  as  an  antiseptic,  by  being  dusted  upon  wounds 

*  See  Gould's  Year-Book  of  Medicine,  1905,  p.  498. 


144  ANTISEPTICS 

after  surgical  operations.  Being  only  slightly  soluble,  it  is  an  excellent 
substitute  for  iodoform.  It  is  soluble  in  190  parts  of  water  and  in  3.4 
parts  of  alcohol. 

MISCELLANEOUS    ANTISEPTICS. 

Among  the  following  agents  will  be  found  none  of  the  ready-made 
proprietary  solutions  or  mixtures  that  are  advertised  so  largely  as 
antiseptics.  Such  are  entitled  to  no  place  in  a  book  that  aims  to  treat 
subjects  in  a  scientific  way,  for  the  basis  of  their  exploitation  is  com- 
mercial, and  their  use  should  be  regarded  as  unethical.  But,  aside 
from  these  considerations,  there  is  evidence  that  they  are  inferior  to 
some  of  our  well-known  simple  agents.  The  only  reason  for  a  reference 
to  such  preparations  here  is  in  order  to  discourage  their  use,  and  this  can 
be  done  upon  the  ground  of  their  inefficiency,  as  shown  below. 

In  a  very  important  series  of  observations  in  the  field  of  mouth  dis- 
infection, Wadsworth,*  working  in  connection  with  the  Health  Depart- 
ment of  New  York  City,  presents  a  comparison  of  the  antiseptic  power 
of  several  of  the  most  popular  of  the  proprietary  solutions  with  that  of 
alcohol. 

His  observations  were  made  with  the  pneumococcus,  which  is  so 
frequently  found  in  the  mouth.  He  found  that  this  bacterium  can  be 
readily  destroyed  in  a  broth  culture,  but  that  in  sputum  its  destruction 
by  harmless  solutions  is  extremely  difficult,  for  the  reason  that,  with 
many  antiseptics,  diffusion  into  sputum  or  into  an  exudate  is  hindered 
by  the  albuminous  matter.  Alcohol  proved  to  be  very  dift'usive  and 
this  property  was  greatly  aided  by  the  addition*  of  glycerin. 

The  observer's  conclusions  include  the  following  statement:  "Of 
all  the  commercial  solutions  studied — listerine,  borine,  borolyptol, 
glycothymoline,  odol  and  Seller's  solution — none  proved  efficient  when 
tested  on  pneumococci  under  the  conditions  most  favorable  for  their 
action.  Formalin,  lysol  and  hydrogen  peroxide  failed  to  act  upon  the 
pneumococci  in  exudates.  In  short,  alcohol  alone,  of  all  antiseptics 
studied,  proved  efficient  when  tested  on  the  pneumococci  inidcr  all  the 
conditions  of  the  experiments." 

Alcohol  was  used  in  the  strength  of  20  to  40  per  cent.  Preference  is 
given  to  a  mixture  of  water,  glycerin  and  30  per  cent,  of  alcohol,  as  being 
readily  dift'usible,  efficient  and  harmless. 

*  Journal  of  Infectious  Diseases,  October,  190G. 


MISCELLANEOUS  ANTISEPTICS  145 

Betanaphthol. — Naphthol  [C10H7OH]. — A  phenol  occurring  in  coal-tar 
but  usually  prepared  from  naphthalin.  It  occurs  in  colorless  or  buff- 
colored  crystals,  having  slight  odor  and  sharp  taste,  soluble  in  1000 
parts  of  water  and  in  0.8  part  of  alcohol;  soluble  also  in  glycerin  and  in 
olive  oil.     It  is  neutral.     Average  dose,  gr.  4  (0.25  gm.). 

Betanaphthol  in  solution  is  useful  to  keep  instruments  sterile  during 
an  operation,  as  it  does  not  corrode  metals.  It  is  applied  as  an  anti- 
septic to  tissues,  from  the  1  :  1000  saturated  aqueous  solution,  which 
may  be  used  to  irrigate  wounds  and  as  a  mouth  wash  freely,  to  the  full- 
strength  alcoholic  solution  (1  :  0.8)  in  the  disinfection  of  root  canals. 
Upon  soft  tissues,  and  as  a  cleansing  and  disinfecting  agent  in  pyorrhea 
alveolaris,  a  1  :  200  or  1  :  300  solution  may  be  used,  prepared  either 
with  alcohol  or  hot  water,  for  it  is  soluble  in  75  parts  of  boiling  water. 
A  saturated  solution  in  hot  water,  allowed  to  cool  to  the  desired  point, 
is  very  useful;  while  some  of  the  drug  precipitates  with  cooling,  the 
solution  will  be  saturated  at  whatever  temperature  used. 

Incompatibility. — With  chlorine  water  or  bromine  water  betanaphthol 
will  produce  a  white  turbidity. 

ResorcinoL — Resorcin  [C6II6O2]. — ^A  phenol  from  various  sources. 
It  occurs  in  colorless  or  pinkish  crystals,  having  a  sweetish  taste,  solu- 
ble in  0.9  part  of  either  water  or  alcohol,  also  soluble  in  glycerin  or 
ether.  It  is  neutral  or  slightly  acid.  Average  dose,  gr.  2  (0.125  gm.). 
This  drug  is  useful  as  a  mouth  antiseptic,  a  2  per  cent,  solution  in  water 
being  a  proper  strength  for  mouth  wash  or  gargle.  It  is  frequently 
employed  in  whooping-cough  to  cleanse  the  throat  and  posterior  nares 
by  instilling  the  2  per  cent,  solution  directly  into  the  nostrils  several 
times  daily.  Although  similar  to  phenol  in  action  and  uses,  it  is  not 
corrosive  and  is  less  dangerous.  The  internal  dose  being  double  that 
of  phenol,  it  can  be  used  in  stronger  solution  (2  to  5  per  cent.)  for 
general  antiseptic  purposes. 

Incompatibility. — The  aqueous  solution  of  resorcin  will  react  with 
chlorinated  lime,  ferric  chloride  or  bromine  water. 

Potassii  Chloras. — Chlorate  of  Potassium  [KCIO3]. — It  occurs  in 
colorless  crystals  or  white  powder,  odorless,  and  having  a  salty  taste. 
It  is  neutral,  soluble  in  11.5  parts  of  water,  soluble  also  in  glycerin,  but 
almost  insoluble  in  alcohol.     Average  dose,  gr.  4  (0.25  gm.). 

The  U.  S.  P.  advises  caution  with  this  salt,  as  explosion  may  occur 
when  it  is  mixed  with  organic  matter  (tannic  acid,  sugar,  etc.),  or  with 
sulphur,  sulphides,  hypophosphites  or  other  easily  oxidizable  substances. 

It  is  not  a  strong  antiseptic,  a  3  per  cent,  solution  failing  to  prevent 
10 


146  ANTISEPTICS 

the  development  of  bacteria.  In  mercurial  or  other  forms  of  stomatitis 
it  is  used  in  saturated  solution  as  a  mouth-wash,  or  in  tablet  form  it 
is  allowed  to  dissolve  slowly  in  the  mouth.  It  is  also  valued  highly  by 
some  as  an  internal  remedy  in  aphthous  stomatitis.  It  has  become  a 
popular  remedy  in  sore-throat,  undeservedly  so,  and  is  bought  and  used 
too  freely.  Great  care  must  be  exercised  in  the  internal  use  of  this 
drug  and  its  indiscriminate  sale  should  be  discouraged,  because  of  its 
poisonous  effects  in  the  blood.  It  can  change  hemoglobin  into  methemo- 
globin,  and  in  large  doses  it  may  also  irritate  the  kidneys.*  On  the 
whole,  it  must  be  said  that  the  usefulness  of  potassium  chlorate  has 
been  overrated  and  its  dangers  not  sufficiently  recognized. 

Incompatibility.- — Besides  the  dangers  mentioned  above,  the  drug  is 
incompatible  with  strong  snlphvric  and  hydrochloric  ocids.  (A  drop  of 
sidyhuric  acid  will  ignite  a  mixture  of  equal  parts  of  potassium  chlorate 
and  sugar.)  An  aqueous  solution  mixed  with  silver  nitrate  will  precipi- 
tate silver  chloride. 

Potassii  Permanganas. — Permanganate  of  Potassium  [KMnOJ. — 
It  occurs  in  dark  purple  crystals,  having  a  characteristic,  unpleasant 
taste:  neutral;  soluble  in  13.5  parts  of  water.  Its  aqueous  solution  is 
rose-colored  when  dilute  and  deep  purple  when  concentrated.  It 
decomposes  in  contact  with  alcohol.  Being  a  powerful  oxidizing  agent 
the  U.  S.  P.  directs  that  it  should  be  kept  in  glass-stoppered  bottles, 
protected  from  light,  and  should  not  be  brought  in  contact  with  organic 
or  readily  oxidizable  substances.    Average  dose,  gr.  1  (0.06' gm.). 

Its  oxidizing  power  makes  it  a  valuable  disinfectant  and  deodorant. 
Applied  to  the  mucous  membrane  of  the  mouth  in  proper  dilution  it  is 
non-irritant,  but  it  produces  a  dirty  brown  stain,  which  is  an  objection 
to  its  use.  However,  the  stain  is  easily  removed  from  accessible  sur- 
faces by  a  solution  of  oxalic  acid.  It  may  be  applied  locally  in  any 
strength  up  to,  or  even  above,  5  per  cent.  Its  action  is  quite  super- 
ficial and  is  to  be  explained  by  the  fact  of  the  liberation  of  oxygen, 
which  unites  with  the  albumin  of  the  tissues.  Very  strong  solutions, 
therefore,  may  be  irritating  and  even  somewhat  caustic  to  mucous 


*  As  examples  of  fatal  poisoning  by  potassium  chlorate  note  the  following:  (1)  A 
woman,  aged  seventy  years,  took  1  ounce  by  mistake  for  Epsom  salt.  Four  hours 
later  she  fainted,  became  cyanosed  and  died  fifteen  hours  after  taking.  (2)  An 
infant  of  three  weeks  died  in  three  days  from  about  1  gm.  (gr.  15),  which  had  been 
dusted  into  its  mouth.  Of  89  cases  recorded,  76  were  fatal.  Witthaus  and  Becker, 
Med.  Jurisprudence,  1896,  vol.  iv. 


MISCELLANEOUS  ANTISEPTICS       ■  147 

membranes.  It  has  been  found  efficient,  and  has  been  extensively  used 
by  surgeons,  as  a  hand  disinfectant  in  preparation  for  operating.  After 
preliminary  scrubbing  of  the  hands  and  nails  with  soap  and  water, 
they  are  immersed  in  a  saturated  aqueous  solution  of  the  permanganate. 
This  is  followed  by  a  solution  of  oxalic  acid  which  removes  the  stain 
of  the  permanganate. 

When  used  as  a  mouth  wash,  1  :  1000  is  a  proper  dilution.  Its  use 
within  a  carious  cavity  is  always  to  be  avoided;  other  agents  are  just 
as  efficient,  without  the  objectionable  staining  quality.  As  an  appli- 
cation to  the  throat  in  diphtheria  or  tonsillar  infection,  and  to  foul 
ulcers,  it  possesses  considerable  value.  In  1  per  cent,  solution  it  has 
been  found  to  destroy  developed  bacteria  and  in  1  :  1000  it  prevents 
their  development.*  It  is  an  efficient  chemical  antidote  to  morphine 
if  given  while  the  latter  is  still  in  the  stomach,  and,  since  morphine  is 
partly  eliminated  into  the  stomach,  in  prolonged  cases  of  poisoning 
the  stomach  may  be  washed  out  at  hourly  intervals  with  a  weak  solution 
(1  :  2000). 

Incompatibility. — ^With  organic  substances,  or  triturated  with  sulphur 
or  other  inflammable  substances,  explosion  may  occur.  For  this  reason 
it  should  not  be  mixed  in  a  closed  vessel  with  syrup  or  glycerin.  With 
carbolic  acid  oxidation  occurs.  Alcohol,  oxalic  acid  or  solution  of 
hydrogen  dioxide  will  decompose  it. 

This  drug  should  be  used  alone  in  a  simple  aqueous  solution. 

Sodii  Thiosulphas.  —  Thiosulphate  of  Sodium.  —  H yposidphite  of 
Sodium  [Na2S203  +  5H2O]. — This  salt  is  soluble  in  0.5  part  of  water 
and  the  solution  is  neutral;  insoluble  in  alcohol.  Its  antiseptic  powder 
makes  it  a  useful  mouth  wash.  It  is  also  a  useful  internal  antiseptic. 
Average  dose,  gr.  15  (1  gm.). 

Zinci  Chloridum. — Chloride  of  Zinc. — (For  general  properties,  see 
under  Escharotics.)  This  substance,  on  account  of  its  germicidal  and 
penetrating  power,  must  be  ranked  among  our  best  antiseptics.  The 
disadvantages  in  its  use  are  the  irritation  it  causes  and  its  coagulant 
action.  For  tooth  disinfection,  especially  in  pulpless  teeth,  these  dis- 
advantages do  not  obtain,  and  strong  solutions  (above  20  per  cent.) 
may  be  used;  while  for  mouth  disinfection  a  1  per  cejit.  solution  may 
be  employed.  It  must  be  remembered  that  its  coagulation  of  albu- 
minous matter  liberates  hydrochlorrc  acid,  which  should  not  remain 

*  Brunton's  Pharmacology,  1885,  p.  96. 


148  ANTISEPTICS 

about  the  teeth,  but  must  be  neutraHzed   at  once.     The   following 
formula  is  typical: 

Gm.  or  mil. 

I^ — Zinci  chloridi 2  4  (gr.  xxxvij) 

Glycerini 30  0  (fgj) 

Aquae  rosse q.  s.  ad     240  0  (fSviij) 

M.  et  Sig. — Use  as  a  mouth  wash. 

Argenti  Nitras. — Nitrate  of  Silver  [AgNOs]. — (For  solubility  and 
properties,  see  under  Escharotics.)  Although  generally  inadmissible 
as  a  mouth  or  tooth  antiseptic  because  of  its  staining  quality,  this 
drug  is  valuable  in  severe  local  infections  of  the  mucous  membrane. 
It  is  destructive  to  the  gonococcus  wherever  found,  and  in  that  severe 
form  of  conjunctivitis  known  as  ophthalmia  neonatorum,  which  is 
usually  a  gonorrheal  infection  of  the  eyes  occurring  during  birth,  nitrate 
of  silver  is  most  relied  upon  as  the  germicide.  Also,  in  order  to  prevent 
this  serious  malady,  the  advice  of  C'rede*  should  be  supported  and 
followed,  which  is,  that  the  eyes  of  all  babes  born  in  charitable  institu- 
tions should  invariably  have  a  2  per  cent.f  solution  of  silver  nitrate 
instilled  into  them  immediately  after  birth,  so  as  to  disinfect  every  part 
of  the  conjunctival  membrane.  As  evidence  of  the  efficacy  of  such 
preventive  treatment,  it  may  be  noted  that  the  statistics  of  large  lying- 
in  institutions  where  it  has  been  employed,  show  that  the  Crede  method 
has  reduced  the  disease  to  less  than  one-fifteenth  of  its  former  pre- 
valence in  the  same  institutions.  Whenever  nitrate  of  silver  is  locally 
applied,  any  excess  may  be  completely  neutralized  by  a  solution  of 
sodium  chloride.  Stains  of  sih-er  nitrate  may  be  removed  by  a  solution 
of  potassium  cyanide  (not  applicable  within  the  mouth  as  the  cyanide 
is  very  poisonous),  or  by  moistening  with  a  solution  of  iodine  followed 
by  sodium  thiosulphate. 

Certain  other  preparations  of  silver  have  been  foimd  to  be  highly 
antiseptic  and  have  come  into  use  in  general  surgery.  Of  these  the 
most  remarkable  is  an  allotropic  form  of  metallic  silver  that  is  solnhle 
in  water  and  in  albuminous  fluids.  The  aqueous  solution  of  this 
(usually  1  per  cent.)  may  be  injected  into  infected  tissues,  and  has 

*  The  justification  for  tliis  advice  is  found  in  the  large  percentage  of  cases  of  blind- 
ness that  are  due  to  this  severe  inflammation,  occurring  as  a  result  of  infection  of  the 
eyes  at  birth.  In  1897  an  investigation  of  the  causes  of  blindness  of  the  306  inmates 
of  the  schools  for  the  blind  in  New  York  State  showed  that  21  per  cent,  of  cases 
were  due  to  ophthalmia  neonatorum.  Howe,  Transactions  of  the  Medical  Society  of 
the  State  of  New  York,  1897. 

t  A  1  per  cent,  solution  is  now  commonly  used. 


MISCELLANEOUS  ANTISEPTICS  149 

even  been  used  intravenously  in  cases  of  septicemia.  It  is  also  used 
in  form  of  ointment  rubbed  into  the  skin.  The  following  non-ofBcial 
preparations  are  also  now  employed  in  general  surgery: 

Silver  Lactate. — Actol  [AgCsHaOs  +  H2O].— This  occurs  in  colorless 
crystals,  easily  affected  by  light,  soluble  in  15  parts  of  water.  An 
aqueous  solution  of  1  :  1000  may  be  used,  as  1  :  300  to  1  :  500  solution 
is  said  to  be  equivalent  to  1  :  1000  mercuric  chloride  solution  in  dis- 
infectant power.* 

Silver  Citrate. — Itrol  [CeHjOvAgs]. — A  white  powder,  soluble  in  3800 
parts  of  water,  said  to  be  destructive  to  all  ordinary  germs  when  used 
in  a  solution  of  1  :  4000.  The  solution  should  be  freshly  prepared. 
It  is  also  used  in  ointment  of  1  to  2  per  cent,  strength. 

Protargol  {Protein  Silver) .—This  substance  is  a  silver  albumose,  con- 
taining 8  per  cent,  of  metallic  silver.  It  is  a  yellowish  powder,  readily 
soluble  in  water,  and  is  less  irritating  than  nitrate  of  silver.  The  reason 
for  this  probably  is  that,  being  an  albumin  compound,  its  application 
to  tissues  is  not  followed  by  the  liberation  of  an  acid,  as  is  the  case  with 
the  nitrate.  It  destroys  various  bacteria,  and  it  has,  therefore,  come 
to  be  used  much  as  a  substitute  for  the  nitrate  in  purulent  inflammations 
of  mucous  membranes,  particularly  when  they  are  gonorrheal  in  nature. 
One  to  5  per  cent,  is  the  strength  of  solution  in  which  it  is  employed. 
As  to  germicidal  power,  Post  and  Nicoll  found  a  10  per  cent,  solution 
about  equivalent  to  1  :  5000  solution  of  silver  nitrate,  f 

Argyrol  {Silver  vitellin). — A  proteid  salt  of  silver  occurring  in  black 
scales,  containing  30  per  cent,  of  metallic  silver.  It  is  freely  solu- 
ble in  water  and  the  solutions  do  not  readily  deteriorate.  It  does 
not  coagulate  albumin  nor  precipitate  chlorides.  It  is  comparatively 
non-irritating  an)d  non- toxic,  therefore,  it  may  be  used  freely  even  in 
strong  solution,  e.  g.,  in  simple  conjunctivitis  5  to  20  per  cent,  may  be 
applied  several  times  daily  and  in  the  gonorrheal  form  25  to  50  per  cent. 
As  an  irrigating  fluid  1  :  1000  may  be  freely  used  and  internally  5  to 
10  grains  may  be  given.  Its  antiseptic  power  is  small  as  compared  with 
silver  nitrate.  Post  and  Xicoll  found  a  50  per  cent,  solution  inferior 
to  a  1  :  10,000  solution  of  silver  nitrate  in  germicidal  power.  |  Stains 
of  argjTol  may  be  removed  by  a  1  :  500  solution  of  mercuric  chloride. 

Preparations  of  silver  have  been  used  internally,  especially  the 
nitrate  and  oxide,  for  alterative  effect.  It  must  be  noted  that  the 
prolonged  internal  use  of  this  metal  should  be  discouraged.     It  is 

*  National  Dispensatory,  1916. 

t  Wood's  Pharmacology  and  Therapeutics,  1916,  2d  ed.  t  Ibid. 


150  ANTISEPTICS 

capable  of  producing  a  permanent  staining  of  tissues,  which  is  outwardty 
shown  by  a  slight  blueness  of  the  skui.  This  condition  is  known  as 
argyria  and  is  due  to  the  deposit  of  silver  in  the  papillary  layer  of  the 
skin.  The  same  condition  may  be  produced  in  a  smaller  area  by  the 
local  use  of  silver  preparations,  where  they  are  allowed  to  enter  the 
tissues. 

Hydrargyri  Chloridum  Corrosivum. — Mercuric  Chloride. — Bichloride 
of  Mercury, — Corrosive  Sublimate. — Perchloride  of  Mercury  [HgCy. — 
Average  dose,  gr.  ^  (0.003  gm.)  This  substance  occurs  in  colorless, 
odorless  crystals,  having  a  disagreeable  metallic  taste,  soluble  in  13.5 
parts  of  Avater,  in  3.8  parts  of  alcohol,  and  in  about  12  parts  of  glycerin. 
It  is  acid  in  reaction,  although  the  addition  of  chloride  of  sodium  to  its 
aqueous  solution  will  render  it  neutral.  Because  of  its  corrosive  proper- 
ties, for  general  antiseptic  purposes  it  is  used  only  in  dilute  solution  of 
1  :  2000  to  1  :  10,000.  However,  for  limited  use  as  a  powerful  disinfect- 
ant, it  may  be  used  as  strong  as  1  :  1000  or  even  1  :  500  in  the  mouth, 
as  in  plantation  cases. 

This  drug  may  cause  poisoning  in  two  ways,  either  as  a  corrosive 
by  local  destruction  of  tissues,  or,  after  absorption,  as  a  systemic  poison. 
In  the  former  case  a  strong  solution  or  the  pure  salt  is  necessary  to 
cause  poisoning,  while  in  the  latter  case  small  doses  continued,  or 
careless  use  of  ordinary  solutions  or  of  any  preparation  of  mercury, 
is  likely  to  cause  systemic  mercurial  poisoning,  with  the  production  of 
salivation.  For  example,  a  single  cathartic  dose  of  calomel,  or  the 
daily  use  of  the  compound  cathartic  pills,  which  contain  1  grain  of 
calomel  each,  has  caused  salivation. 

This  powerful  drug  will  seldom  be  the  antiseptic  of  first  choice  in 
dental  practice.  Its  unpleasant,  metallic  taste  prevents  its  use  as  a 
mouth-wash.  As  a  tooth  disinfectant  it  is  seldom  used  because  of  the 
danger  of  staining  the  tooth  through  the  formation  of  sulphide  of 
mercury.*  It  corrodes  instruments,  therefore  cannot  be  used  to  steri- 
lize them,  although  glassware  may  be  easily  sterilized  by  the  solution 
of  1  :  1000. 

In  spite  of  all  disadvantages  mercuric  chloride  remains  as  one  of  the 
most  efficient  germicides.  In  general  medicine  and  surgery  the  weaker 
solutions  (1  :  3000  to  1  :  10,000)  are  u.sed  cautiously  and  for  a  short 
time,  to  irrigate  wounds  and  abscess  cavities,  to  disinfect  ulcers,  and 
as  douches  mto  the  several  passages  of  the  body.     Whenever  used,  a 

*  See  remarks  on  metallic  stains  in  Kirk's  article  on  "Discolored  Teeth  and  their 
Treatment,"  American  Text-book  of  Operative  Dentistry,  second  edition,  page  559. 


MISCELLANEOUS  ANTISEPTICS  151 

free  escape  of  the  solution  must  be  insured,  and  its  use  in  these  ways 
should  rather  be  regarded  as  a  temporary  necessity,  to  be  supplanted  by 
safer  agents.  As  a  rule,  it  should  not  be  combined  with  other  sub- 
stances. 

Incompatihility. — Mercuric  chloride  mixed  with  livie-water,  ammonia 
or  carbonates  of  the  alkalies,  will  produce  a  precipitate.  With  a  solution 
of  soap  a  precipitate  of  mercurial  soap  occurs.  With  potassium  iodide 
red  iodide  of  mercury  is  formed.  Hydrogen  sulphide  causes  a  black 
precipitate  of  mercuric  sulphide.  With  siher  nitrate  a  deposit  of 
chloride  of  silver  occurs.  Metals  are  tarnished  by  it,  amalgamation 
occurring  with  silver  and  some  others.     Albumin  is  coagulated  by  it. 

Acute  Poisoning. — The  symptoms  of  acute  poisoning  by  this  drug  are 
those  produced  by  any  corrosive  irritant — i.  e.,  pain  in  the  stomach, 
with  vomiting  and  prostration.  The  chemical  antidote  is  albumin. 
(See  Table  of  Poisons  and  Antidotes.) 

Systemic  Poisoning  or  Mercurialism. — Only  the  soluble  salts  of  mercury 
are  capable  of  causing  local  irritation,  but  any  preparation  of  this  metal 
may  cause  mercmialism.  The  symptoms  of  this  condition  may  come 
on  without  any  gastric  disturbance;  in  fact,  it  is  fortunate  that  the 
first  indications  of  systemic  saturation  occur  in  the  mouth,  where  they 
are  at  once  noticed  and  easily  recognized;  and  the  dentist  should  be 
familiar  with  the  early  symptoms  of  this,  possibly  disastrous,  toxic 
disturbance. 

The  first  symptom  will  be  hyperemia  of  the  more  vascular  structures, 
the  pericementum  and  gums,  causing  in  the  former  slight  tenderness 
upon  forcible  closure  of  the  jaws,  and  in  the  latter  redness.  If  the 
condition  progresses,  the  soreness  of  the  teeth  becomes  decided  and 
an  increased  flow  of  saliva  occurs,  with  decided  fetor  of  the  breath. 
This  gives  the  picture  of  salivation  in  a  positive  degree;  fortunately 
the  superlative  degree,  with  ulceration  and  loss  of  teeth,  is  almost  never 
seen  today  because  of  smaller  quantities  of  the  drug  now  given,  with 
the  decline  of  the  antiphlogistic  methods  of  treatment  which  were 
formerly  in  vogue.  The  elimination  of  mercury  in  the  saliva,  from  a 
system  saturated  with  it,  is  probably  responsible  for  the  occurrence 
of  the  ulcerative  stomatitis  seen  in  severe  cases.  Right  here  let  it  be 
stated  that  detection  by  the  dentist  of  the  early  symptoms  of  mercuri- 
alism should  call  forth  no  reflection  upon  the  physician  who  prescribed 
mercury.  This  for  two  reasons:  (1)  The  condition  may  have  occurred 
accidentally  through  idiosyncrasy — i.  e.,  a  special  susceptibility  of  the 
patient  to  the  action  of  the  drug,  which  is  sometimes  seen;  or,  the 


152  ANTISEPTICS 

patient  may  have  exceeded  directions  and  used  the  medicine  carelessly. 
(2)  The  condition  may  be  intentional,  for,  in  the  treatment  of  syphilis, 
the  use  of  mercury  in  some  form  is  often  pushed  to  saturation  for  a 
time. 

Treatment  of  Mercurialisni. — The  patient  will  complain  of  two  symp- 
toms if  the  condition  is  well  developed:  (1)  soreness  of  the  teeth,  and 
(2)  the  constant  flow  of  saliva  which  may  interfere  with  sleeping. 
These  will  need  to  be  relieved.  Relief  of  the  pericementitis  and  stoma- 
titis must  be  brought  about  by  elimination  through  other  channels 
than  the  salivary  and  oral  glands.  The  bowel  being  the  most  natural 
route  for  the  elimination  of  mercury,  saline  cathartics,  freely  given,  by 
then  power  of  withdrawmg  serum  from  the  blood,  will  serve  our  purpose 
best.  The  salivation  may  be  controlled  by  belladonna  or  its  alkaloid, 
atropine.  Of  the  tinctm-e  give  5  minims  (0.3  gm.),  or  of  atropme 
gr.  ^0  0  (0.0006  gm.)  two  or  three  times  daily.  This  is  the  best  drug  for 
this  purpose,  as  it  checks  the  salivary  secretion  very  decidedly  and  is 
not  disturbing  to  the  system  if  used  properly.  Opium,  or  morphine, 
also  causes  dryness  of  the  mouth,  but  the  systemic  effects  are  unpleas- 
ant; and  on  the  whole  they  are  inferior  to  belladonna.  A  mouth 
wash  of  solution  of  potassium  chlorate  (2  to  4  per  cent.)  is  often 
used  in  addition.  Reports  have  also  been  made  of  the  very  successful 
use  of  hydrogen  dioxide  in  this  condition.  One  part  of  the  official 
solution  to  3  of  water,  as  a  mouth  wash  every  half  hour,  is  recom- 
mended. Its  peculiar  detergent  property  makes  it  particularly  appli- 
cable to  severe  cases,  where  ordinary  antiseptics  are  less  useful.  \Yith 
improvement  in  the  condition,  the  saline  cathartics  should  still  be 
continued  until  the  drug  is  believed  to  have  been  thoroughly  eliminated. 
Potassium  iodide  has  long  been  used  to  aid  elimination  of  this  as  of 
other  heavy  metals.  The  dose  is  10  to  30  grains  (0.6-2  gm.)  three  times 
daily.  It  is  believed  to  form  the  more  soluble  iodide,  which  then 
passes  out  through  the  kidneys. 

Carbo  Ligni.- — Wood  Charcoal. — Employed  as  deodorant. 

Carbo  Animalis. — Anbial  Charcoal  (not  official). — Prepared  from 
bone;  employed  as  a  decolorizing  agent  in  preparing  organic  solutions. 

Carbo  Animalis  Purificatus.^ — Purified  Animal  Charcoal. — Bone- 
black  (not  official). — The  purification  consists  in  decalcifying  by  boiling 
for  hours  in  hydrochloric  acid  diluted  with  water.  It  is  employed  as 
an  antidote  to  organic  poisons. 

Charcoal  of  any  kind  is  not  really  antiseptic,  but  it  is  deodorant  and 
detergent  and  has  marked  absorbent  jjower.     Ob^•iously  its  applica- 


MISCELLANEOUS  ANTISEPTICS  153 

tion  to  mouth  conditions  is  limited,  though  its  general  value  should  be 
appreciated. 

Wood  charcoal,  prepared  from  soft  wood  because  more  porous,  is 
least  powerful  of  the  group,  but  it  has  the  power  of  absorbing  gases  to 
a  large  extent — e.  g.,  it  is  said  to  be  capable  of  absorbing  ninety  times 
its  own  volume  of  ammonia  gas.  It  destroys  foul  gases  by  absorbing 
and  condensing  them  within  its  pores.  This  power  may  be  increased 
by  platinizing  the  charcoal. 

In  order  to  be  an  efficient  deodorant,  wood  charcoal  must  either  be 
fresh,  or  have  been  recently  heated  so  as  to  destroy  organic  impurities 
that  may  have  been  taken  up  through  exposure  to  the  air. 

Animal  charcoal  is  a  more  powerful  absorbent,  being  capable  of 
extracting  coloring  matters  from  organic  solutions.  It  may  be  used 
in  decolorizing  galenical  preparations  of  drugs. 

Purified  animal  charcoal  is  too  powerful  to  use  in  decolorizing  solu- 
tions of  drugs,  for  it  is  capable  of  extracting  organic  principles,  such  as 
tannin,  alkaloids  and  resins,*  whereby  the  strength  of  the  product 
would  be  lessened.  Because  of  this  behavior  toward  organic  principles, 
purified  animal  charcoal  has  a  distinct  V'alue  as  an  antidote  to  alkaloids 
and  other  organic  poisons. 

All  charcoals  should  be  kept  in  well- closed  containers,  so  that  their 
absorbent  power  may  not  be  exhausted  by  absorption  of  gases  from 
the  atmosphere. 

Dental  Uses. — About  the  only  use  to  which  charcoal  could  be  properly 
put  is  to  cleanse  a  foul  mouth,  such  as  is  too  often  met  with  among 
ignorant  people.  Its  practical  application  is  questionable.  It  is  not  a 
proper  ingredient  of  tooth  powders,  because  of  the  sharpness  of  its 
particles. 

Hydrogen  Dioxide. — This  compound,  having  the  chemical  formula  of 
H2O2,  is  used  in  several  strengths  as  an  antiseptic.  Its  value  depends 
upon  the  extra  oxygen  which  it  contains  and  which  it  gives  up  readily 
when  brought  into  conditions  that  favor  its  decomposition.  It  is, 
therefore,  an  oxidizing  agent,  the  oxygen  liberated  in  nascent  condi- 
tion giving  it  three  distinct  properties  w^hich  make  it  especially  valuable 
in  dental  practice,  it  being  a  disinfectant,  a  detergent  and  a  bleaching 
agent. 

A  compound  that  yields  its  oxygen  so  readily  is,  of  course,  unstable; 
but  it  has  been  found  that  a  solution  containing  3  per  cent,  of  pure 

*  U.  S.  Dispensatory,  eighteenth  edition,  page  329. 


154  ANTISEPTICS 

hydrogen  dioxide  in  water  keeps  its  strength  and  quaUties  for  months  at 
ordinary  temperatures.  Higher  strength  sohitions  require  the  addition 
of  considerable  acid  or  other  preservative,  and  must  be  looked  upon 
as  unstable  and  dangerous  to  handje.  A  25  per  cent,  ethereal  solution 
is  put  up  in  closed  glass  tubes  with  certain  precautions  noted  upon 
the  label.  In  this  strength  the  agent  is  a  decided  caustic  and  must  be 
handled  with  care,  its  chief  use  being  as  a  bleaching  agent. 

The  official  solution  is  called : 

Liquor  Hydrogenii  Dioxidii — Solution  of  Hydrogen  Dioxide  [H2O2]. 
This  is  a  colorless  liquid,  slightly  acid  in  reaction,  and  it  contains 
when  freshly  prepared,  not  less  than  3  per  cent.,  by  weight,  of  the  pure 
dioxide.  It  is  also  known  as  the  "ten  volume"  solution,  as  it  yields 
upon  decomposition  about  ten  times  its  own  volume  of  oxygen.  The 
acid  it  contains  is  necessary  to  its  preservation.  Average  dose,  f51 
(4  mils.). 

The  most  characteristic  property  of  this  liquid  is  its  foamy  decom- 
position in  contact  wdth  organic  matter,  by  the  activity  of  which  its 
strength  can  be  roughly  estimated. 

It  gradually  loses  strength  by  keeping,  though  it  is  stated  that 
deterioration  will  be  retarded  if  the  stopper  of  the  bottle  be  coated 
with  paraffin,  or  if  a  stopper  of  cotton  be  employed  instead  of  an  ordi- 
nary cork  stopper.     It  should  be  kept  in  a  cool  place. 

It  decomposes  when  heated  or  exposed  to  sunlight,  also  when  in 
contact  with  charcoal,  oxides  of  manganese,  potassium  permanganate, 
alkalies,  blood,  pus  and  other  loosely  organized  matter,  besides  many 
other  chemical  substances.  Mixed  with  a  solution  of  potassium  iodide 
it  liberates  iodine.  As  a  rule,  it  should  be  used  alone,  so  as  to  avoid 
unexpected  decomposition. 

When  the  3  per  cent,  solution  is  applied  to  the  tissues  it  decomposes 
with  some  energy,  because  of  the  rapidity  and  abundance  of  the  liber- 
ation of  oxygen.  Upon  a  tender  mucous  membrane  the  action  may  be 
so  irritating  as  to  require  dilution  of  the  liquid.  The  oxygen  in  nas- 
cent condition  is  a  powerful  germicide  and  disinfectant,  cleansing  the 
surface  of  the  tissue  thoroughly  without  injury,  for  it  does  Jiot  coagulate, 
nor  constringe,  nor  penetrate.  Its  action  is  solely  that  of  an  oxidizing 
agent,  and  any  irritation  from  it  corresponds  to  the  energy  of  oxygen 
liberation.  As  a  gargle  or  mouth  wash  it  may  be  employed  in  full 
strength  of  the  official  solution  (3  per  cent.)  or  diluted.  With  children 
it  is  usually  diluted  to  one-half  or  one-quarter  strength. 

It  should  be  regarded  distinctively  as  an  antiseptic  that  does  not 


MISCELLANEOUS  ANTISEPTICS  155 

injure  healthy  tissues.  Its  special  value  lies  in  its  power  to  oxidize, 
disintegrate  and  destroy  disorganized  tissue,  such  as  pus;  and  in  dis- 
infecting abscess  cavities  it  has  the  further  advantage  of  distending  the 
cavity  by  the  expansion  resulting  from  the  liberation  of  oxygen,  so  that 
every  portion  of  the  cavity  and  its  walls  are  reached  by  the  oxygen. 
Distention  of  an  abscess  cavity  in  this  way  will  cause  momentary  pain, 
but  scarcely  more  than  attends  the  use  of  a  coagulating  or  penetrating 
antiseptic. 

In  tooth  and  root-canal  disinfection  the  dioxide  is  used  freely.  In 
removing  pus  and  cleansing  the  pockets  in  pyorrhea,  in  the  cleansing 
of  ulcers  and,  in  fact,  in  any  local  infectious  condition,  hydrogen  dioxide 
is  an  ideal  disinfectant.  But  the  mistake  should  not  be  made  of  expect- 
ing of  this  substance  properties  that  it  does  not  possess.  It  is  not 
antacid,  it  is  not  coagulant,  it  is  not  astringent,  it  does  not  affect  healthy 
tissue.  Its  action  is  upon  disorganized  tissue,  blood,  pus  and  bacteria. 
The  one  indication  for  its  use  is  the  presence  of  infection .  One  exception 
must  be  made  under  the  general  statements  as  to  its  use  in  abscess 
cavities;  it  should  not  be  used  in  the  antrum  with  its  unyielding  bony 
wall,  unless  a  very  free  opening  has  been  made.  Very  severe  pain 
might  easily  attend  its  use  ordinarily  in  empyema  of  the  antrum,  on 
account  of  pressure  from  the  rapid  expansion  of  the  liberated  oxygen. 

Systemic  effects  never  occur  from  the  proper  use  of  hydrogen 
dioxide;  therefore,  it  is  non-toxic.  However,  by  its  hypodermic  use 
some  of  the  unchanged  dioxide  may  be  absorbed  into  the  circulation  and 
cause  disorganization  of  blood  elements  with  the  production  of  emboli. 
An  animal  may  easily  be  killed  by  intravenous  injection  of  dioxide  of 
hydrogen.     As  a  bleaching  agent  this  substance  is  discussed  elsewhere. 

Quininae  Sulphas. — Quinine  Sulphate  [(C2oH2402N2)2.H2S04  +  7H2O]. 
Quinine,  the  chief  alkaloid  of  cinchona  bark,  is  used  in  the  form  of 
various  salts,  but  mostly  as  the  sulphate.  This  occurs  in  white,  silky 
crystals  or  as  hard,  prismatic  needles;  soluble  in  725  parts  of  water, 
107  parts  of  alcohol  and  in  30  parts  of  glycerin.  [Acids  aid  the  solu- 
bility of  quinine  and  of  the  sulphate.  The  bisulphate  and  several 
other  salts  are  much  more  soluble  than  the  sulphate.]  Average  dose, 
tonic,  gr.  1|  (0.1  gm.)  three  times  daily;  anti-malarial,  at  least  gr.  15 
(1  gm.)  daily. 

While  this  drug  is  classed  as  antipyretic  and  anti-malarial,  the  latter 
action  is  most  important  and  is  really  antiseptic.  It  is  the  most  typical 
internal  general  antiseptic  in  use.  Not  only  is  its  action  in  the  diges- 
tive tract  destructive  of  some  of  the  intestinal  infections,  such  as  amebic 


156  ANTISEPTICS 

dysentery,  but,  in  the  blood  of  malarial  subjects  it  readily  destroys 
the  Plasmodium  malaria,  which  is  the  specific  organism  of  malarial 
or  intermittent  fever.  In  order  to  be  absorbed  into  the  blood  in  suffi- 
cient strength  to  accomplish  this  it  must  be  given  in  large  doses  daily 
for  a  week  or  more;  but  even  thus  it  is  comparatively  harmless  to  the 
system,  the  only  unpleasant  effects  being  ringing  in  the  ears  and  slight 
temporary  deafness.  The  term  cinchonisni  is  applied  to  these  symptoms 
of  the  full  action  of  quinine.  The  former  use  of  quinine  in  large  doses, 
to  combat  inflammation  (antiphlogistic),  is  now  nearly  obsolete. 

Incornpatibility. — (See  Incompatibility  of  Alkaloids.) 

Chinosol. — Quinosol  [C9H6X.KSO4  +  H2O]  (not  official). — Chemi- 
cally this  drug  is  oxy-quinoline-potassium-sulphate,  occurring  in  yellow 
crj^stals  having  an  astringent,  aromatic  taste  and  readily  soluble  in 
water,  but  insoluble  in  alcohol.  It  is  not  a  coagulant,  therefore  not 
destructive  to  tissue.  It  may  be  used  in  a  1  :  1000  aqueous  solution 
as  a  general  antiseptic  wash,  but  for  local  uses,  such  as  application  to 
abscess  cavities,  empyema  of  the  antrum,  etc.,  1  to  2  per  cent,  solutions 
may  be  used. 

Incoinpatihility. — With  lead  acetate  or  mercuric  chloride  precipitates 
.will  occur,  while  the  addition  oi  ferric  chloride  will  produce  a  bluish- 
green  color.  Steel  instruments  are  tarnished  but  not  corroded  by  the 
drug. 

Formaldehyde  [CH2O]. — This  valuable  addition  to  our  materia  medica 
is  a  gas,  usually  obtained  by  the  partial  oxidation  of  methyl  alcohol. 
It  is  one  of  the  most  powerful  disinfectants  known,  ranking  almost 
with  corrosi\'e  sublimate.  It  fills  a  place  that  no  other  agent  does  as 
a  really  eft'ective  and  practicable  disinfectant  gas.  It  is  far  superior  to 
sulphurous  acid  gas  in  respect  to  efficiency,  penetrating  power  and 
non-action  upon  metallic  furnishings.  A'arious  lamps  and  other  appa- 
ratus for  generating  the  gas  for  extensive  use  have  been  devised,  and 
small  fumigators  or  candles  for  limited  use,  as  in  the  disinfection  of 
books,  instruments  and  clothing  in  a  small  air  space.  The  gas  is  very 
irritating  to  the  eyes  and  to  the  air  i)assages.  As  a  medicinal  agent 
formaldehyde  is  employed  in  its  official  aqueous  solution,  as  below. 

Liquor  Formaldehydi. — Solution  of  Formaldehyde. — Formalin. — 
This  is  an  aqueous  solution  containing  not  less  than  'A7  per  cent,  of 
formaldehyde  gas.  It  has  a  pungent  odor  and  caustic  taste,  being  irri- 
tant to  tissues.  It  is  the  commercial  form  of  the  drug  and  is  miscible 
with  water  and  with  alcohol  in  any  proportion.  It  should  be  neutral 
or  only  faintly  acid  in  reaction.     ri)on  standing  it  may  become  cloudy 


MISCELLANEOUS  ANTISEPTICS  157 

from  the  separation  of  paraformaldehyde.  A  stronger  sohition  is 
unstable.  A  much  weaker  solution  must  be  used  for  application  to 
living  tissues,  for  this  substance  is  characterized  by  its  penetrating  quaUiy 
and  irritant  action. 

While  this  di'ug  has  the  power  to  harden  tissues  to  a  marked  degree, 
the  action  is  not  a  coagulation  in  the  ordinary  sense.  When  applied  to 
a  mucous  membrane,  it  does  not  coagulate  appreciably.  In  contact 
with  egg  albumin  it  coagulates  the  latter  only  slightly.  In  fact,  it  seems 
to  hinder  the  coagulation  of  albuminous  liquids  to  which  it  has  been 
added;  for  egg  albumin  and  serum  are  not  precipitated  by  heat,  nor  is 
casein  coagulated  by  the  rennet  enzyme,  after  being  thus  treated.* 
Compared  with  carbolic  acid,  the  local  action  of  formalin  is  less  corrosive 
and  more  penetrating;  it  is  on  the  whole  more  irritating,  except  for  the 
momentary  pain  caused  by  the  former.  The  result  of  its  action  is  a 
deeper  hardening  of  the  tissues  to  which  it  is  applied.  Because  of  the 
continued  irritation  which  it  occasions,  it  cannot  be  used  extensively 
as  a  general  antiseptic  to  the  soft  tissues,  except  in  very  dilute  solution. 
Even  for  disinfection  of  the  hands,  it  has  been  largely  discarded  as  being 
too  irritating  for  daily  use.  As  a  mouth-wash,  0.5  per  cent,  of  formalin 
should  never  be  exceeded.  For  disinfection  of  pulpless  teeth  5  per  cent. 
may  be  used,  but  many  have  discarded  it  as  being  undesirable  in  any 
gfiicient  strength,  and  liable  to  work  injury  beyond  the  apical  foramen. 

On  the  whole,  it  must  be  said  that  formalin  is  not  gaining  favor  as 
a  general  antiseptic  for  application  to  the  tissues  of  the  body.  The 
experiments  of  Hunt  and  Jackson  f  rate  the  1  :  200  solution  of  formalin 
as  far  inferior  to  the  same  strength  of  benzoic  acid  and  to  1  :  2500 
solution  of  mercuric  chloride,  for  mouth  disinfection.  Harrington  found 
that  a  1  per  cent,  solution  of  formaldehyde  failed  to  kill  the  Staphylo- 
coccus pyogenes  aureus  in  sixty  minutes,  while  a  2  per  cent,  solution 
required  forty-five  minutes,  and  a  5  per  cent,  solution  twenty  minutes 
to  destroy  the  same  organism.  J 

As  an  agent  to  prevent  the  growth  of  mouth  bacteria.  Peck  found 
pure  formaldehyde  in  1  :  1000  solution  hardly  one-fourth  as  potent  as 
the  same  strength  of  bichloride  of  mercury  solution.  §  In  his  experi- 
ments formalin  proved  to  be  a  dangerous  escharotic  when  kept  in 
contact  with  soft  tissues. 

*  Cushny's  Pharmacology,  5th  edition,  p.  479. 

t  Transactions  of  the  Dental  Society  of  the  State  of  New  York,  1904,  p.  94. 

t  Annals  of  Surgery,  October,  1904. 

§  Dental  Review,  August,  1898,  p.  607. 


158  ANTISEPTICS 

Formocresol,  largely  used  in  root  canal  work,  consists  of  equal  parts 
of  solution  of  formaldehyde  and  cresol. 

An  important  use  of  formaldehyde  is  in  the  hardening  and  pre- 
servation of  anatomic  and  pathological  specimens.  A  5  per  cent, 
solution  of  formalin  is  commonly  employed.  The  advantages  of  this 
agent  over  alcohol  is  that  the  color  of  the  specimen  is  better  retained, 
and  the  tissue  does  not  shrink  to  any  great  degree. 

Paraformaldehydum. — Paraform. — Average  dose  gr.  S  (0.5  gm.) .  This 
polymeric  form  of  formaldehyde  occurs  in  white  masses  or  powder, 
slowly  soluble  in  cold  water,  more  readily  in  hot  water,  insoluble  in 
alcohol.  It  has  a  slight  odor  of  formaldehyde,  which,  given  off  slightly 
at  ordinary  temperature,  is  evolved  rapidly  when  heat  is  applied.  This 
points  to  its  extensive  use,  in  the  form  of  "formaldehyde  candles,"  in 
disinfecting  rooms  and  clothing. 

In  dentistry  it  is  used  in  various  combinations  for  root  filling  and 
pulp  mummification.     The  following  are  favorite  combinations: 
For  root  filHng: 
Chloro-percha  and  Formaldehyde. 

Guttapercha  (baseplate) 10  parts 

Chloroform 25      " 

Eucalyptol 15      " 

Thymol 2      " 

Paraform    ..." 1  part 

Dissolve  the  guttapercha  in  the  chloroform.  Dissolve  the  thymol 
in  the  eucalyptol,  add  the  paraform,  finely  powdered,  and  shake  well. 
Mix  the  two  solutions,  and  keep  the  bottle  open  in  a  warm  place  until 
the  chloroform  has  evaporated.     (Prinz.) 

For  pulp  mummifying: 

Paraform 1  part 

Thymol ■. 1      " 

Zinc  oxide 2  parts 

Glycerin  sufficient  to  make  a  stiff  paste.  (Prinz.) 

Hexamethylenamina. — Urotropin  [C6H12N4]. — This  substance  is  a 
chemical  compound  of  formaldehyde  and  ammonia.  It  occurs  in  color- 
less crystals  or  white  powder,  soluble  in  1.5  parts  of  water  and  in  12.5 
parts  of  alcohol.  Average  dose,  gr.  4  (0.25  gm.).  The  aqueous  solu- 
tion is  alkaline.  The  chief  value  of  urotropin  is  as  an  antiseptic  to 
the  urinary  tract.  The  explanation  of  its  action  is,  that  when  elimi- 
nated by  the  kidneys  it  is  decomposed  into  formaldeh}'de  and  ammonia, 
the  former  acting  then  as  an  antiseptic.  It  is  a  very  efficient  agent,  but 
the  urine  must  be  acid,  in  order  to  secure  a  reliable  effect,  and  quite 
large  doses,  even  up  to  gr.  20  (1.30  gm.),  are  often  employed. 


CHAPTER  XII. 
BLEACHING  AGENTS. 

The  art  of  removing  discolorations  of  the  teeth  has  for  years  engaged 
some  of  the  best  thought  of  the  dental  profession,  with  the  result  that 
today  we  may  say  that  the  bleaching  of  teeth  has  become  a  science. 
With  causes  of  discoloration  well  known  and  properly  classified^  the 
chemical  reactions  necessary  to  discharge  the  color  may  usually  be 
secured  with  certainty.  Moreover,  the  appreciation  on  the  part  of  the 
patient  is  usually  commensurate  with  the  effort  expended. 

The  excellent  chapter  on  "Discolored  Teeth  and  their  Treatment," 
by  Dr.  Ku"k,  in  the  American  Text-hook  of  Operative  Dentistry,  gives 
a  systematic  presentation  of  present-day  knowledge  of  methods  of 
bleaching  discolored  teeth,  which  must  stand  as  the  authority  of  today 
upon  this  special  subject.  The  province  of  the  chapter  here  presented 
is  to  deal  with  substances  rather  than  detailed  methods  of  their  appli- 
cation. The  chief  agents  employed  to  bleach  teeth  are  discussed,  there- 
fore, as  to  their  properties,  action  and,  in  general,  their  uses. 

There  must  necessarily  be  a  chemical  basis  for  the  action  of  these 
agents,  for  it  is  inconceivable  that  colors  could  be  discharged  by  the 
action  of  such  strong  chemicals  as  chlorine  and  nascent  oxygen  without 
the  occurrence  of  chemical  reactions. 

The  substances  employed  in  the  treatment  of  ordinary  discolorations 
are  conveniently  grouped  into 

(a)  Agents  that  furnish  free  chlorine,  or  indirect  oxidizers. 
(6)  Agents  that  furnish  nascent  oxygen,  or  oxidizing  agents, 
(c)  Agents  that  have  an  affinity  for  oxygen,  or  reducing  agents. 

For  the  removal  of  metallic  stains,  additional  agents,  chiefly  in  the 
nature  of  solvents,  are  required.  While  the  use  of  chlorine  to  secure  a 
change  of  the  metallic  deposit  to  a  chloride,  followed  by  thorough 
washing  with  warm  distilled  water,  is  held  to  be  the  general  rule  of 
treatment,  its  final  success  may  depend  upon  the  solubility  of  the 
chloride.  Chlorides  are  commonly  soluble  in  water,  but  silver  chloride 
is  an  exception,  it  being  entirely  insoluble.  Hence,  in  removing  silver 
stains  the  chlorine  treatment  is  followed  by  a  saturated  solution  of 


160  BLEACHING  AGENTS 

sodium  thiosulphate  (hyposulphite),  which  is  a  sol\-ent  for  chloride  of 
silver.  In  removing  stains  of  manganese  the  final  washing  must  be  with 
a  solution  containing  oxalic  acid.  In  case  of  mercurial  stain,  Kirk 
advises  the  use  of  an  aqueous  ammoniacal  solution  of  hydrogen  dioxide 
after  the  chlorine  treatment. 


CHLORINE    GROUP. 

Chlorine. — The  value  of  chlorine  gas  as  a  bleacher  depends  largely 
upon  its  affinity  for  hydrogen,  by  which  it  may  either  directly  break  up 
the  color  molecule  or  liberate  oxygen  from  the  water  molecule.  In 
the  former  case  it  is  a  direct  decolorizer,  and  in  the  latter  it  is  indirectly 
an  oxidizer.  The  gas  is  now  seldom  applied  directly  to  the  tooth, 
although  the  Wright  method  employed  it  this  way  with  good  results, 
but  the  complicated  apparatus  needed  prevented  its  general  adoption. 
At  the  present  time  it  is  applied  either  in  solution  or  in  a  loosely 
combined  preparation  which  yields  it  up  readily. 

The  official  preparations  yielding  chlorine  in  sufficient  strength  to 
be  of  any  value  in  bleaching  are  the  following: 

Liquor  Sodse  Chlorinatae. — Solution  of  Chlorinated  Soda. — Labar- 
raqiie's  Solution. — This  liquid  contains  at  least  2.5  per  cent,  of  available 
chlorine. 

Calx  Chlorinata. — Chlorinated  Lime. — This  is  a  whitish  powder 
containing  at  least  30  per  cent,  of  available  chlorine.  The  powder 
deteriorates  upon  exposure  to  the  air,  becoming  moist  and  losing  its 
strong  odor  of  chlorine.  If  kept  in  metal  containers  it  is  unfit  for 
bleaching  teeth,  because  of  the  liability  of  metallic  contamination. 
It  is  preferably  kept  in  paraffined  card- board  packages  or  in  bottles. 
To  be  fit  for  use  it  must  be  dry  and  should  exhale  a  strong  odor  of 
chlorine. 

When  either  chlorinated  lime  or  Labarraque's  solution  of  chlori- 
nated soda  is  employed,  it  is,  after  being  placed  in  the  tooth,  treated 
with  any  dilute  acid,  usually  50  per  cent,  of  either  acetic  acid  or  tar- 
taric acid,  in  order  to  free  the  chlorine  more  rapidly.  The  use  of 
chlorinated  lime  in  this  way  constituted  the  original  Truman  method 
of  bleaching  teeth. 

The  incompatibilities  with  chlorine  are  stated  in  the  chapter  on 
Antiseptics. 


OXYGEN  GROUP  161 


OXYGEN   GROUP. 


Hydrogen  Dioxide. — This  substance  and  its  properties  are  discussed 
fully  in  the  chapter  on  Antiseptics.  While  the  official  3  per  cent, 
solution  possesses  some  degree  of  bleaching  power,  its  use  has  been 
largely  superseded  by  that  of  the  "caustic  pyrozone"  or  25  per  cent, 
ethereal  solution.  Its  value  depends  upon  the  nascent  oxygen  which  it 
liberates.  Kirk*  states  that  "more  rapid  and  permanent  effects  are 
produced  when  the  pyrozone  solution  is  rendered  alkaline,"  which  may 
be  done  by  the  addition  of  a  little  of  one  of  the  solutions  of  the  pure 
alkalies,  either  aqua  ammonise  fortior  or  solution  of  potassium  or 
sodium  hydroxide.  Special  care  must  be  taken  in  handling  and  using 
the  25  per  cent,  solution,  on  account  of  its  caustic  action  upon  the  fingers, 
which  may  be  prevented  by  first  oiling  them. 

Sodium  Dioxide. — Sodiu:h  PsROxroE  [Xa202]  (not  official). — ^This 
occurs  as  a  yellowish-white  powder  that  absorbs  water  readily  when 
exposed  to  the  air,  with  deterioration  of  its  activity.  It  is  caustic, 
soluble  in  water,  and  strongly  alkaline.  Its  value  as  a  bleacher  is 
threefold : 

1.  It  liberates  nascent  oxygen  as  does  hydrogen  peroxide,  but  after 
parting  with  one  of  its  atoms  of  oxygen  it  still  possesses  caustic  and 
alkaline  properties.     (Kirk.) 

2.  It  possesses  some  solvent  power  upon  albuminous  matter. 

3.  It  has  the  power  of  saponifying  fats. 

Thus  it  not  only  acts  as  an  oxidizer,  but  as  a  detergent. 

It  is  applied  in  saturated  aqueous  solution,  which  must  be  prepared 
at  a  low  temperature  in  order  to  avoid  loss  of  strength.  If  weaker 
solutions  are  desired  in  some  cases,  they  may  be  prepared  from  the 
saturated  solution  by  diluting  carefully  with  water. 

Benzoyl-acetyl  Peroxide. — Acetozone. — Bemozone  [CeHsCOOOCOC- 
Hs]  (not  official). — In  a  comparative  experimental  study  of  bleachers f 
Dr.  Hoff  has  obtained  results  that  would  seem  to  place  this  new  agent 
next  to  hydrogen  dioxide  and  sodium  dioxide.  He  describes  it  as  an 
organic  peroxide,  whose  decomposition  products  are  not  destructive  to 
the  tooth  structure.  It  acts  slowly,  and  it  may  be  allowed  to  remain 
for  some  time  within  the  cavity. 

This  drug  is  obtained  in  form  of  a  whitish  powder,  consisting  of 

*  American  Text-book  of  Operative  Dentistry, 
t  Dental  Cosmos,  February,  1902. 
11 


162  BLEACHING  AGENTS 

equal  parts  of  the  pure  crystal  and  an  inert  powder,  which  makes  a 
cloudy  solution  in  water.  The  solubility  of  the  crystals  in  water  varies 
from  1  :  1000  to  1  :  10,000.  It  is  slightly  soluble  in  alcohol  and  in 
ether.  Nearly  all  solvents,  including  water  and  alcohol,  decompose  it 
gradually.  It  should  be  kept  in  small,  well-stoppered  bottles  in  a  cool 
place,  securely  protected  from  moisture,  and  from  contact  with  organic 
matter,  alkalies,  alcohol  and  other  solvents. 

In  aqueous  solution  this  drug  is  claimed  to  be  a  very  powerful,  non- 
toxic germicide. 

Potassium  Permanganate  parts  readily  with  its  oxygen  when  brought 
into  contact  with  organic  matter.  Its  disadvantage  as  a  bleaching 
agent  is,  that  the  resulting  compounds  are  dark-colored  and  require 
to  be  treated  with  a  solution  of  oxalic  acid  in  order  to  complete  the 
decolorization. 

REDUCING   AGENTS. 

Sulphur  Dioxide  [SO2]  (not  official). — A  gas. 

Acidum  Sulphurosum. — Sulphurous  Acid. — An  aqueous  solution  con- 
taining not  less  than  6  per  cent.,  by  weight,  of  sulphur  dioxide  gas. 

Both  are  bleaching  agents  by  reason  of  their  affinity  for  oxygen. 
However,  they  do  not  destroy  organic  pigments,  as  the  color  may  be 
largely  restored  by  an  alkali  or  a  stronger  acid,  according  to  Witthaus. 
The  dioxide  (SO2)  possesses  the  stronger  affinity,  being  oxidized  in  the 
presence  of  water  to  sulphurous  acid  (SO3H2),  and  finally  to  sulphuric 
acid  (SO4H2).  The  dioxide  gas  being  preferable,  Kirk  advocates  the 
use  of  a  mixture  of  10  parts  of  sodium  sulphite  and  7  parts  of  boric  acid 
which,  being  packed  into  a  tooth  and  moistened  with  water,  may  be 
quickly  sealed  in  with  a  temporary  filling.  A  reaction  occurs  between 
the  two  substances  with  liberation  of  sulphur  dioxide.  The  bleaching 
process  by  this  method  is  slower  than  by  the  use  of  the  peroxides. 

The  solution  in  water  known  as  sulphurous  acid  is  less  efficient  than 
the  gas,  but  still  may  be  employed.  It  must  be  remembered  that  the 
final  product  of  oxidation  of  this  class  of  bleachers  is  sulphuric  acid, 
which  must  be  thoroughly  removed  or  neutralized. 

Incompatibility. — Sulphurous  acid  gas,  or  its  solution,  is  incompatible 
with  acids,  with  ferric,  mercuric,  and  silver  salts,  with  carbonates  and 
with  sohdions  of  iodine. 

Sodii  Bisulphis. — Bisulphite  of  Sodium  [NaHSOs]. 

Sodii  Sulphis. — Sulphite  of  Sodium  [Na2S03  -f  7H2O]. 

These  salts  are  freely  soluble  in  water,  and  when  exposed  to  air  lose 


REDUCING  AGENTS  163 

sulphur  dioxide.  They  are  of  use  as  sources  of  sulphur  dioxide  gas 
when  they  are  decomposed.  In  bleaching  of  teeth  the  sulphite  chiefly 
is  used,  as  in  the  process  noted  above.  (See  also  under  Antiseptics.) 
Sodii  Thiosulphas. — Hyposulphite  of  Sodiuivi  [Xa2S203  +  5H2O].— 
This  salt,  soluble  in  0.5  part  of  water,  is  used  in  saturated  solution  to 
remove  the  silver  chloride  resulting  from  previous  treatment  of  silver 
stains  with  chlorine. 


CHAPTER   XIII. 
ANESTHETICS— LOCAL  ANALGESICS. 

Anesthetics  are  agents  used  to  abolish  sensibility,  for  the  purposes 
of  surgical  treatment,  the  relief  of  spasm,  and  the  alleviation  of  severe 
pain.  Complete  general  anesthesia  includes  unconsciousness,  due  to 
paralysis  of  the  cerebral  cortex,  and  loss  of  excitability  of  all  centers  of 
reflex  action,  except  those  concerned  in  the  functions  of  respiration  and 
circulation.  Local  anesthesia  means  usually  the  abolition  of  sensibility 
to  iKtin  in  a  certain  locality.  It  is  rather  a  condition  of  analgesia,  which 
is  defined  to  be  the  absence  of  sensibility  to  pain,  as  distinguished  from 
anesthesia,  which  means  the  absence  of  all  sensibility. 

When  confronted  by  the  necessity  of  a  surgical  operation,  a  decision 
must  be  made  first  as  to  the  advisability  of  using  an  anesthetic,  then, 
as  to  whether  local  or  general  anesthesia  shall  be  employed,  and  finally 
the  choice  of  the  agent  must  depend  upon  the  condition  of  the  patient, 
the  length  of  time  required  for  the  operation  and  the  comparative  safety 
of  the  drugs  from  which  a  selection  is  to  be  made. 

In  major  operations  the  necessity  of  general  anesthesia  appears  at 
once,  and  the  chief  point  will  be  the  choice  of  the  drug  to  be  used.  In 
minor  operations,  such  as  the  extraction  of  a  tooth  or  the  lancing  of  an 
abscess,  we  should  not  resort  too  readily  to  general  anesthesia.  We 
should  rather  allow  the  patient  to  assume  the  responsibility  of  deciding 
to  take  an  anesthetic.  And  in  case  of  a  prolonged  or  severe  operation  in 
dental  practice,  the  patient's  physician  should,  as  a  rule,  assume  the 
responsibility  of  deciding  what  anesthetic  shall  be  used,  and  also  super- 
vise its  administration.  The  use  of  local  analgesics  may  be  more  readily 
resorted  to  for  any  minor  operation  about  the  mouth. 

LOCAL  ANALGESICS. 

These  agents  are  employed  to  paralyze  the  sensory  nerve  endings  to 
painful  impressions  in  a  limited  region.  They  produce  their  effects  in 
two  ways,  and  are  accordingly  classified  into: 

Refrigerant  Analgesics,  or  those  which  cause  an  abstraction  of  heat 
from  the  part,  even  to  the  point  of  freezing  the  tissue,  and 


REFRIGERANT  ANALGESICS  165 

Paralyzant  Analgesics,  or  those  which  have  a  specific  paralyzant  action 
upon  the  sensory  nerve  terminals. 

REFRIGERANT  ANALGESICS. 

Ice  and  salt  mixture. 
Rhigolene  spray. 
Ether  spray. 
Chloride  of  ethyl  spray. 
.  The  value  of  all  of  these  depends  upon  the  operation  of  the  physical 
law  that  a  solid  in  changing  to  a  liquid,  or  a  liquid  changing  to  a  vayor 
requires  a  certain  amount  of  heat  to  effect  the  change.    The  heat  so  required 
is  abstracted  from  the  surrounding  medium  and  becomes  latent  in  the 
new  form  of  the  substance,  being  necessary  to  the  maintenance  of  that 
form. 

When  a  mixture  of  ice  and  salt  is  applied  to  tissue,  heat  is  abstracted 
so  rapidly  by  the  melting  ice  that  the  part  may  be  frozen  superficially. 
The  only  use  of  the  salt  in  the  mixture  is,  by  its  affinity  for  water,  to 
make  the  ice  melt  more  rapidly.  It  would  be  impossible  to  freeze  tissue 
by  the  application  of  ice  alone,  because  of  the  slow  abstraction  of  heat. 
One  danger  in  the  application  of  ice  and  salt  is  freezing  too  intensely  or 
too  extensively,  which  may  induce  sloughing  of  tissue.  The  more  salt 
there  is  added  to  the  ice  up  to  a  certain  point  the  more  rapidly  will  freez- 
ing occur.  Therefore,  to  a  given  quantity  of  ice,  pounded  fine,  one-fourth 
to  one-third  as  much  salt  should  be  added.  They  should  be  well  mixed 
and  applied  in  such  manner  that  heat  may  be  abstracted  only  from  the 
part  to  be  operated  upon. 

This  mixture,  probably  the  earliest  of  all  local  analgesics,  must  still  be 
accorded  a  place  of  usefulness,  although  it  has  been  largely  superseded 
by  the  highly  volatile  liquids  whose  effects  are  so  easily  secured  and 
controlled.  It  may  be  used  upon  an  accessible  surface,  but  within  the 
mouth  it  is  certainly  inferior  to  a  spray. 

The  liquids  used  for  local  analgesic  purposes  must  be  very  volatile  at 
or  below  the  temperature  of  the  body,  so  as  to  evaporate  rapidly  when 
sprayed  upon  the  tissues.    The  following  have  been  employed: 

^ther  (Ethylic).— Boils  at  about  95°  F.  It  is  very  inflammable,  the 
vapor  forming  an  explosive  mixture  with  the  air. 

Rhigolene  (not  official),  a  distillate  of  petroleum,  boiling  at  65°  F, 
It  may  be  explosive  under  certain  conditions. 

.ffithylis  Chloridum. — Ethyl  Chloride. — Boils  at  55°  F.  As  a  liquid 
it  burns  with  a  smoky  flame;  and  its  vapor  is  very  inflammable. 


166  ANESTHETICS— LOCAL  ANALGESICS 

The  comparison  of  boiling-points  and  inflammability  of  the  above 
agents  indicates  the  superiority  of  ethyl  chloride,  Avhich  is  practically  the 
only  one  used  at  present. 

Chemically,  ethyl  chloride  [C2H5CI]  is  an  ester  resulting  from  the 
action  of  hydrochloric  acid  gas  upon  absolute  alcohol.  It  is  a  colorless 
liquid,  inflammable  and  extremely  volatile,  with  a  specific  gravity 
of  0,918  at  46.4°  F,  The  specific  gravity  of  its  vapor  is  2.22,  It  is  put 
up  for  use  in  sealed  tubes  containing  |  or  1  fluidounce.  By  means  of  a 
capillary  opening  through  the  glass  stopper  a  very  minute  jet  is  emitted, 
which  is  directed  upon  the  part  to  be  frozen.  Thus  there  is  no  waste, 
and  the  fine  stream  may  be  forced  a  distance  of  a  foot  or  more,  especially 
if  the  pressure  within  the  tube  be  increased  by  enclosing  it  in  the  warm 
hand.  The  action  of  the  drug  is,  therefore,  easily  controlled  and  may  be 
secured  at  any  point  within  the  mouth  without  endangering  the  tissues. 


Fig.  4.— Chloride  of  ethyl  spray  tube. 

Some  pain  attends  the  freezing  of  tissue  by  whatever  means  induced, 
but  this  disadvantage  is  outweighed  by  the  assurance  the  patient 
acquires  that  the  pain  of  the  operation  will  be  much  lessened. 

Indeed,  for  the  extraction  of  a  tooth,  the  mental  effect  of  the  harmless 
chloride  of  ethyl  application  may  be  taken  advantage  of  to  nerve  a 
hesitating  or  nervous  person  up  to  a  point  of  ready  cooperation.  With 
this  agent  several  teeth  may  be  extracted  at  one  sitting  with  prac- 
tically no  danger;  however,  by  inhalation  the  drug  has  been  found  to 
be  a  quick  and  powerful  general  anesthetic,  whose  safety  seems  to  be 
less  than  that  of  ether;  so  that,  in  its  local  use  in  the  mouth,  care  should 
be  exercised  to  avoid  the  occurrence  of  general  anesthesia.  One-half 
to  one  fluidrachm  (2-4  mils)  quickly  inhaled  may  easily  cause  uncon- 
sciousness. The  full  effect  of  the  local  application  is  shown  by  blanching 
of  the  tissues  at  the  point  of  evaporation.  The  action  being  chiefly 
upon  the  gums,  the  real  advantage  to  be  sought  is  painless  application 
of  the  forceps.  We  cannot  expect  the  actual  pain  of  extraction  to  be 
entirely  removed. 

On  the  whole,  the  use  of  this  substance  is  to  be  highly  recommended. 


TECHNIQUE  OF  LOCAL  ANESTHESIA  167 

Its  convenience,  readiness,  safety  and  comparative  efficacy  give  it  a  sum 
of  advantages  not  possessed  by  any  other  local  analgesic  for  slight  opera- 
tions.   As  a  general  anesthetic  it  is  considered  in  Chapter  XIV. 

PARALYZANT  ANALGESICS. 

The  paralyzant  class  of  local  analgesics  includes  the  following  drugs, 
which  are  here  compared  as  to  solubility,  their  other  properties  and 
uses  being  discussed  in  regular  order.    The  first  three  are  oflficial. 

Cocaine  Hydrochloride,  soluble  in  0.4  part  of  water,  2.3  parts  of  alcohol. 

Beta-eucaine  Hydrochloride*  soluble  in  30  parts  of  water  and  in  35 
parts  of  alcohol. 

Quinine  and  Urea  Hydrochloride,  soluble  in  1  part  of  water  and  in  2| 
parts  of  alcohol. 

Tropacocaine  Hydrochloride,  readily  soluble  in  water. 

Nirvanin,  easily  soluble  in  water. 

Stovaine,  soluble  in  2  parts  of  water  and  readily  in  alcohol. 

Alypin,  very  soluble  in  water  and  in  alcohol. 

Novocaine,  soluble  in  1  part  of  water,  freely  in  alcohol. 

Apothesine,  readily  soluble  in  water  and  in  alcohol. 

Orthoform,  slightly  soluble  in  water,  freely  in  alcohol. 

These  all  obtund  or  paralyze  the  sensory  nerve  terminals  wherever 
they  are  applied,  afi^ecting  chiefly  sensibility  to  pain.  They  produce 
very  little  effect  upon  the  unbroken  skin.  Upon  mucous  membrane, 
whose  texture  is  less  firm,  their  effect  is  decided,  but  their  full  action  is 
only  obtained  when  they  are  applied  to  a  denuded  surface  or  injected 
hypodermically;  except,  that  in  the  application  to  the  very  sensitive 
mucous  membranes  of  the  eye  a  complete  effect  is  quickly  obtained, 
although  no  abrasion  be  present. 

Three  dangers  are  recognized  as  pertaining  to  the  use  of  these  drugs: 

1.  Damage  to  the  tissues  treated,  leading  at  times  to  sloughing. 

2.  General  poisoning. 

3.  Formation  of  habit. 

TECHNIQUE  OF  LOCAL  ANESTHESIA. 

To  attain  success  in  the  practice  of  local  anesthesia  it  is  essential 
that  the  operator  should  possess  suitable  instruments  and  exercise 
infinite  care  in  the  preparation  and  use  of  the  solution  selected. 

The  syringe  should  be  strongly  constructed  and  should  permit   of 

*  Alpha-eucaine,  being  more  irritating,  is  now  seldom  used. 


168 


ANESTHETICS— LOCAL  ANALGESICS 


sterilization  by  boiling.  Such  syringes  may  be  of  the  all-metal  type  or 
the  barrel  may  be  of  glass.  The  needles  should  be  selected  with  due 
regard  to  the  accessibility  of  the  part  to  be  operated  upon. 

The  solution  should  be  freshly  prepared  for  each  case.  It  is  conven- 
ient to  use  tablets  containing  definite  amoiuits  both  of  the  drug  and  of 
s^'nthetic    suprarenin.     These    should  })e  dissolved   in  either  normal 


Fig.  5. — Hypodermic  syringe. 

saline*  or  Ilinger's  solution. f  A  1  or  2  per  cent,  solution  of  the  drug 
is  suitable  for  all  dental  operations.  There  are  on  the  market  small 
graduated  porcelain  dishes  with  standard  and  handle,  in  which  the 
solution  may  be  prepared  and,  where  permissible,  boiled  over  a  Bimsen 
burner  or  alcohol  lamp. 


Fig.  6. — Boiling  cup. 


The  injections  about  the  teeth  may  be  made  in  any  of  the  following 
ways  according  to  the  requirements  of  the  case:  vSnbperiosteal,  intra- 
osseous, peridental  or  submucous.  The  area  to  be  injected  should  first  be 
painted  with  tincture  of  iodine  diluted  with  an  equal  cjuantity  of  grain 
alcohol.  Thorough  asepsis  should  be  practised  throughout  the  operation. 

*  Normal  saline  solution  is  known  officially  as  Physiological  Solutioti  of  Sodium 
Chloride  and  consists  of  0.85  per  cent,  of  sodium  chloride  in  distilled  water. 

t  Ringer's  solution  imitates  closely  the  salinity  of  the  blood  plasma,  containing, 
in  distilled  water,  sodium  chloride,  0.7  per  cent.;  potassium  chloride,  0.03  per  cent.; 
calcium  chloride?,  0.025  per  cent. 


COCA. 

The  leaves-of  Erythroxylon  Coca 
and  its  varieties. 

The  alkaloid  Cocaine  fully  rep- 
resents the  druff. 


Classified  as  : 
Cerebral  stimulant. 
Mydriatic. 
Local  analgesic. 
General  protoplasmic  poison. 

Physiologic  action 
The  drug  pro- 
duces fii'st  a  de- 
scending stimula- 
tion of  the  central 
nervous  system,  followed  by 
a  descending  depression  if  a 
large  dose  has  been  taken. 
The  succession  may  be  irreg- 
ular, so  that  a  case  of  cocaine 


PLATE    II. 


Scnsoi'U 
nerve  endings 

depressed 

when  locallyj 
uppUcd. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sym23athetic 


poisoning    may  show  mixed  Voluntay^y 
symptoms  of  stimulation  and 
depression. 

The  two  diagrams  presented  (Plates  II.  and  III.^ 
stimulant  and  depressant  effects  respectively. 
Stomach.     The  local  effect  is  to  benumb  the  sensory  nerve  endings 
in  the  stomach. 

Nervous  System. 

Brain.     Simuilates  the  cerebral  cortex. 
Medulla.     Stimulates  respiratory  and  vasomotor  centres. 
Spinal  cord.     Stimulates  reflex  centres. 
Sensory  nerve  endings  are  always  depressed  when  the 
drug  is  applied  locally. 
Muscular  System.     Increases  irritability  and  working   power  of 

voluntary  muscles. 
Eye.     Dilates  pupil  by  stimulating  dilator  nerves. 
Circulation.     Arterial  pressure  is  increased. 
Heart.     Action  accelerated  by  direct  stimulation  either  of 

heart  muscle  or  of  the  accelerator  nerves. 
Capillary  area.      Contracts  arterioles  by  stimulation   of 
vasomotor  centre  in  the  medulla  and  by  direct  action  upon 
the  vessel  walls. 

Respiration.     Rate  increased  by  stimulation  of  respiratory  centre. 
Elimination.     Cocaine  has  been  detected  in  the  urine,  but  its  in- 
fluence upon  the  kidneys  is  variable  and  uncertain,  therefore 
probably  indirect. 


Solar  Plexus 


The  red  color  indicates 
the  stimulant  effects 
of  Cocaine. 


PLATE    III. 


Arterioles 
relaxed 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


COCAIXE. 

The  poisonous  effects  of  Coca, 
or  the  secondaiy  effects  of  a  large 
dose,  are  depressant,  following 
quite  definitely  the  lines  of  pre- 
vious stimulation. 


Nervous  System. 

Brain.  Cerebi-al  functions  are 
depressed,  frequently  with 
production  of  narcosis  or 
convulsions. 
Medulla.  Depresses  respira- 
tory center  and  probably 
vaso-motor  center. 
Spinal  cord.  Depresses  re- 
flex centers. 

Circulation.  Arterial  pressure  is 
lessened. 

Heart.  Depressed  by  dii-ect 
action  of  the  drug. 

Capillary  area.  Ai-terioles 
relaxed,  probably  through 
paralysis  of  vasomotor  cen- 
ter. 

Respiration.  Depresses  the  respi- 
ratory functions  by  lessening 
the  irritability  of  the  center 
in  the  medulla. 


In  general,  the  depressant  ac- 
tion is  that  of  a  general  proto- 
plasmic poison,  the  commonest 
evidence  of  which  is  its  paral- 
yzant influence  upon  nerve  tissue 
when  locally  applied. 


For  local  analgesic  purposes  the 
alkaloid  Cocaine  is  employed  in 
from  i  to  4  per  cent,  solutions. 


The  blue  color  indicates  the  depressant  eflfects  of  a  toxic 
dose  of  Cocaine. 


CONDUCTIVE  OR  REGIONAL  ANESTHESIA  169 

CONDUCTIVE  OR  REGIONAL  ANESTHESIA. 

In  addition  to  the  simple  local  use  of  this  group  of  drugs,  their  appli- 
cation has  been  extended  to  anesthetize  a  whole  extremity  or  region 
supplied  by  a  certain  nerve.  This  is  accomplished  by  injection  of  the 
drug  into  and  about  the  nerva  at  some  point  in  its  course.  If  thor- 
oughly done,  painful  sensation  will  be  abolished  in  all  the  region  of  dis- 
tribution of  the  nerve.  While  this  method  may  be  employed  to  secure 
anesthesia  for  a  surgical  operation,  the  same  is  also  advocated  to  prevent 
shock  from  operations  upon  the  extremities.* 

This  method  of  producing  regional  anesthesia  is  coming  into  wide 
use  by  the  dental  practitioner  and  possesses  many  points  of  merit.  But 
before  this  method  is  taken  up  the  dentist  should  become  thoroughly 
familiar  with  the  technique  as  well  as  possess  an  exact  knowledge  of  the 
anatomy  of  the  parts.  It  is  also  quite  necessary  that  the  operator 
possess  the  necessary  paraphernalia  for  properly  carrying  out  the  exact- 
ing technique  of  this  method.  Injections  should  be  made  at  the  point 
where  the  trunk  of  the  nerve  supplying  the  part  may  be  reached,  as  in 
the  following  locations:  zygomatic,  infra-orbital,  anterior  palatine,  pos- 
terior palatine,  pterygomandibular  or  mental,  according  to  the  areas 
which  ar€  to  be  anesthetized.  The  student  is  referred  to  the  more 
exhaustive  treatises  on  this  subject  for  the  minute  details  of  technique. 

Cocainse  Hydrochloridum  [C17II21O4XHCI],  average  dose  gr.  \ 
(0.015  gm.). — This  agent  stands  as  the  typical  local  analgesic.  It  is  a 
neutral  salt  of  the  alkaloid  cocaine,  from  the  leaves  of  ErytJiroxylon  coca, 
grown  chiefly  in  Peru  and  Bolivia.  ^Yhile  the  alkaloid  was  discovered 
about  1860,  and  its  peculiar  analgesic  power  observed  soon  after,  its 
introduction  to  the  medical  world  as  a  practical  local  analgesic  was  due 
to  Karl  Roller,  who  in  1884  reported  experiments  to  the  Congress  of 
German  Oculists.  In  a  few  weeks  cocaine  was  being  used  all  over  the 
world,  t 

Administered  internally,  the  coca  leaves  and  their  preparations,  as 
well  as  the  alkaloid,  are  stimulating  to  the  nervous  system  in  small  doses 
and  depressing  and  poisonous  in  large  doses.    (See  Plates  II  and  III.j 

Locally  applied  to  sensory  nerves,  cocaine  is  always  depressing. 
Applied  to  the  tongue  it  removes  the  sense  of  taste  for  bitter  substances, 
diminishes  it  for  sweet  and  acid  substances,  while  for  salt  it  is  not 
appreciably  lessened.    When  taken  into  the  stomach  it  diminishes  the 

*  See  footnote  on  page  170. 
t  Park's  History  of  Medicine. 


170  ANESTHETICS— LOCAL  ANALGESICS 

sensibility  of  the  organ,  thereby  lessening  the  sense  of  hunger,  and 
probably  impairs  the  activity  of  digestion.  The  sense  of  touch  may  be 
lessened  by  it,  but  the  most  marked  result  of  its  application,  and  the 
most  desirable,  is  the  removal  of  the  sense  of  pain.  The  temperature 
sense  for  heat  and  cold  is  not  diminished.  Applied  locally  into  the  eye 
it  causes  dilatation  of  the  pupil  in  addition  to  the  analgesic  effect.  It 
usually  is  applied  as  directly  as  possible  to  the  terminal  endings  of  the 
sensory  nerve,  but  will  produce  the  same  effect  if  applied  to  the  nerve 
trunk  anywhere  in  its  course.*  It  should  be  noted  that  cocaine  has  a 
deleterious  effect  upon  all  kinds  of  tissue  when  applied  in  any  but  very 
small  quantities;  therefore  it  is  classed  as  a  general  protoplasmic  poison. 
The  reason  for  the  prominence  of  its  effect  upon  nerve  tissue  is,  that  we 
are  here  dealing  with  the  tissue  that  is  a  medium  of  sensation  and  expres- 
sion, and  its  impairment  is,  therefore,  more  easily  appreciated.  Being 
one  of  the  drugs  that  combines  a  stimulant  (early)  effect  with  a  depres- 
sant (later)  effect,  the  greatest  degree  of  caution  must  be  exercised  to 
avoid  the  habitual  use  of  the  drug  by  patients.  It  is  one  of  the  most 
seductive  of  the  drugs  that  are  taken  habitually,  and  its  effects  are  most 
disastrous.  Particularly  is  it  unwise  to  order  this  drug  for  the  patient 
to  use  at  home,  whether  as  gargle,  mouth  wash  or  nasal  spray. 

Observation  has  shown  that  the  system  acquires  a  tolerance  of  large 
doses  of  cocaine  when  it  is  taken  habitually,  as  is  the  case  with  morphine, 
the  quantity  taken  daily  in  some  cases  reaching  as  high  as  30  grains. 
The  drug  is  often  taken  as  a  substitute  for  morphine,  or  as  an  antagonist 
to  it.  The  effects  of  cocaine  taken  habitually  seem  to  be  more  rapidly 
disastrous  than  those  of  morphine. 

In  the  practical  use  of  the  drug  the  hydrochloride  of  cocaine  is  preferred 
to  the  simple  alkaloid,  because  of  its  greater  solubility.  Alkaloids,  as  a 
rule,  are  only  sparingly  soluble  in  water,  hence  their  salts  are  commonly 
employed.  Cocaine  illustrates  this  rule,  being  soluble  only  in  600  parts 
of  water,  while  the  hydrochloride  is  soluble  in  0.4  part  of  water.  It  is 
also  soluble  in  2.3  parts  of  alcohol. 

*  We  are  indebted  to  Dr.  G.  W.  Crile  for  some  facts  concerning  the  value  of  cocaine 
in  blocking  nerve  trunks  to  the  transmission  of  sensory  impressions  from  an  injured 
part  of  the  body.  By  very  careful  experiments  he  has  come  to  the  conclusion  that 
one  prominent  factor  in  surgical  shock  is  the  depression  of  the  vasomotor  system 
by  exhaustion  of  the  centers.  This  occurs  through  their  excessive  stimulation  by 
sensory  impressions  coming  from  the  site  of  injury  or  operation.  In  operations  upon 
the  extremities,  he  prevents  shock  by  "nerve-blocking"  with  cocaine,  i.  e.,  by  inject- 
ing the  drug  about  the  nerve  trunk  so  as  to  abohsh  its  power  of  carrying  sensory 
impressions. 


COSDUCTIVE  OR  REGIONAL  AXESTHESIA  171 

It  is  obtained  in  form  of  crystals  or  a  crystalline  powder,  permanent 
in  the  air  and  bitter  to  the  taste,  leaving  a  sensation  of  nmnbness  on 
the  tongue. 

Solutions  of  cocaine  hydrochloride  do  not  keep  well  beyond  a  few 
days,  neither  can  they  be  sterilized  by  boiling  without  impairing  their 
value.  The  practitioner  must  either  make  up  his  solution  when  needed, 
renew  it  frequently,  or  else  add  some  antiseptic  to  preserve  it.  If  it  is 
desired  to  keep  the  solution  more  than  a  few  days  a  very  little  phenol 
(I  to  1  per  cent.)  may  be  added  to  prevent  the  growth  of  organisms,  and 
in  this  strength  the  coagulant  action  of  the  latter  drug  is  scarcely  noticed. 
Boric  acid  likewise  is  used  as  a  preservative  in  the  proportion  of  2h  per 
cent,  in  the  aqueous  solution  of  cocaine.  Salicylic  acid  is  also  recom- 
mended m  the  strength  of  0.1  per  cent.  1  :  1000;.  Chloretone  is  used 
by  somie  in  the  strength  of  i  to  ^  per  cent. 

Local  Action  of  Cocaine. — The  chief  interest  of  the  dental  surgeon  m 
this  drug  centers  about  its  use  as  applied  locally  to.  or  injected  beneath, 
the  mucous  membrane.  ^A  hen  applied  to  the  membrane  of  the  mouth 
the  bitterness  of  the  drug  is  marked.  The  pure  crystal  or  a  strong 
solution,  .5  to  10  per  cent.,  will  cause  some  anemia  of  the  surface,  which 
is  probably  due  to  a  constrictor  action  upon  the  arterioles,  and  at  the 
same  time  sensitiveness  of  the  tissues  to  pain  will  be  abolished  to  the 
depth  of  penetration  by  the  drug.  For  surface  treatment,  or  upon 
so  sensitive  a  mucous  membrane  as  that  of  the  eye,  direct  application 
of  cocaine  in  1  to  4  per  cent,  solution  is  sufficient:  but  for  extraction  of 
teeth  such  application  is  of  no  use.  The  drug  must  be  injected  into  the 
tissues  about  the  socket  of  the  tooth.  When  this  is  done  there  occius 
immediately  a  blanching  of  the  tissues  at  the  site  of  injection,  which 
is  due  partly  to  forcible  distention  by  the  fluid  injected,  and  probably 
partly  to  vascular  constriction,  .^ome  pain  attends  the  use  of  the  drug 
in  this  way,  but  it  occurs  only  at  the  moment  of  injection,  and  is  quickly 
succeeded  by  complete  analgesia  of  the  locality.  The  vasoconstriction 
is  often  foUowed  by  a  relaxation  that  permits  liA^peremia  of  the  tissues, 
which  may  be  more  or  less  painful.  This,  however,  must  be  regarded 
as  a  secondary  and  later  effect,  occurring  rather  after  than  during  the 
operation. 

Dosage. — The  strength  of  cocaine  solutions  employed  varies  from 
I  to  -4  per  cent.,  according  to  the  rapidity  and  degree  of  effect  desired, 
the  total  quantity'  used  being  limited  by  considerations  of  safety.  The 
maximumi  quantity  allowed  to  gain  entrance  into  the  circulation  at  one 
time  should  not  exceed  one-quarter  of  a  grain.     This  ought  to  be  the 


172  ANESTHETICS— LOCAL  ANALGESICS 

limit  in  the  ordinary  nse  of  the  drng  by  hypodermic  injection.  However, 
the  free  bleeding  of  the  tissues  following  extraction  will  remove  some  of 
the  drug,  and  may  modify  our  estimate  of  the  quantity  that  may  be 
safely  injected  in  a  given  case.  A  1  per  cent,  solution  will  usually  suffice, 
and  of  this  twenty-five  minims  contain  one-quarter  of  a  grain.  When 
application  is  made  to  the  surface  of  the  mucous  membrane  of  the  mouth, 
or  when  the  drug  is  used  by  cataphoresis,  stronger  solutions  may  be 
required;  and  when  the  drug  is  so  applied  that  absorption  occurs  only 
through  the  unbroken  mucous  membrane,  a  larger  quantity  may  be 
used,  but  should  never  exceed  one-half  of  a  grain,  which  is  the  maximum 
dose  for  stomach  administration.  For  direct  application  to  the  pulp 
of  a  tooth,  a  small  quantity  of  a  stronger  solution  or  a  little  of  the  pure 
crystal  may  be  employed. 

An  excellent  rule  in  the  interest  of  exactness  of  dose  and  ease  of 
calculation  is  given  by  Burchard.*  It  is  "to  make  the  solution  upon 
the  basis  of  8  grains  of  the  cocaine  salt  to  1  ounce  of  the.  menstruum 
which  will  give  1  grain  in  each  drachm  and  ^-^  of  a  grain  in  each  minim." 
This  solution  would  be  a  little  less  than  2  per  cent,  in  strength.  Ten 
minims  would  ec^ual  |  of  a  grain,  which  would  be  within  the  safe  hypo- 
dermic dose  for  an  adult. 

That  this  drug  is  one  of  the  most  dangerous  of  those  in  daily  use  is 
attested  by  the  many  cases  of  cocaine  poisoning  that  are  upon  record. 
Among  those  well  authenticated  is  the  case  of  a  girl,  eleven  years  of  age, 
whose  death  resulted  in  forty  seconds  from  the  hypodermic  injection 
of  12  drops  of  a  4  per  cent,  solution,  or  about  |  grain. f  In  another 
case  death  is  said  to  have  been  caused  by  the  application  of  20  drops 
of  a  5  per  cent,  solution  (1  grain)  to  the  gum.  J 

Among  other  cases  of  severe  poisoning  by  cocaine,  without  a  fatal 
result,  the  following  are  noted  :§ 

T.  H.  Burchard  reports  a  case  in  which  10  drops  of  a  4  per  cent, 
solution  hypodermically  caused  unconsciousness  and  apparent  death  in 
four  minutes;  Meyerhausen,  a  case  in  which  8  drops  of  a  2  per  cent, 
solution  upon  the  conjuncti^'a  of  a  girl  of  twelve  years  produced  ^•iolent 
symptoms;  Stevens,  one  in  which  4  minims  of  a  3^  per  cent,  solution 
caused,  in  a  man,  violent  convulsions  followed  by  mania;  Frost,  a  case 
of  a  child  of  fourteen  in  which  1  drop  of  a  1  per  cent,  solution  in  the 
eye  caused  marked  poisoning.    Idiosyncrasy  must  probably  account  for 

*  American  Text-l)ook  of  Operative  Dentistry,  second  edition,  page  641. 

t  Wood's  Therapeutics,  eleventh  edition,  page  201. 

X  ll)id.  §  Ibid. 


CONDUCTIVE  OR  REGIONAL  ANESTHESIA  173 

the  occurrence  of  such  cases,  but  the  fact  that  they  are  not  rare 
should  lead  to  great  care  and  discrimination  in  the  employment  of 
cocaine. 

Schleich  Infiltratian  Method.  This  consists  of  infiltration  of  the 
tissues  with  a  very  weak  solution  of  cocaine  by  a  series  of  contiguous 
injections,  which  produce  really  a  local  edema.  Three  different  strengths 
of  cocaine,  approximately  1  :  500;  1  :  1000  and  1  :  10,000,  are  employed 
as  the  case  demands.*  To  the  solution  is  added  0.2  per  cent,  of  sodium 
chloride  and  small  quantities  of  morphine  hydrochloride  and  phenol. 
The  1  :  1000  is  the  strength  commonly  used.  Undoubtedly  the  pressure 
of  distention  by  the  larger  bulk  of  solution  injected  contributes  to  the 
analgesia,  for  it  has  been  found  that  forcible  distention  of  tissues  by 
sterile  water  often  sufEces  for  slight  operations.  This  method  has  the 
advantage  of  permitting  a  large  quantity  of  solution  to  be  used,  and  a 
longer  operation  to  be  performed  with  much  less  danger  of  cocaine 
poisoning. 

A  number  of  ready-made  solutions  for  local  analgesia  are  upon  the 
market.  They  are  primarily  commercial  articles,  and  it  is  safe  to  say 
that  cocaine  or  some  substitute  forms  the  basis  of  their  formulas.  There 
is  no  reason  why  a  qualified  practitioner  should  select  a  commercial 
formula  instead  of  making  up  his  own  solution,  when  using  so  powerful 
a  drug. 

There  is  absolutely  no  guarantee  of  the  composition  and  uniformity 
of  the  proprietary  analgesic  preparations,  even  though  the  names  of 
ingredients  are  given;  while  if  the  practitioner  orders  by  his  own  formula 
of  official  drugs,  his  pharmacist  can  guarantee  acciu-acy. 

The  advantages  claimed  for  special  formulas  are:  first,  that  they 
contain  substances  that  aid  the  desired  action  and  permit  a  lessening 
of  the  quantity  of  cocaine  used;  second,  that  they  contain  one  or  more 
physiologic  antagonists  to  cocaine,  which  will  counteract  any  possible 
toxic  action;  or,  third,  that  they  keep  better  than  a  simple  solution  of 
cocaine.  All  of  these  objects  are  desirable,  but  it  is  better  for  the  dentist 
himself  to  intelligently  and  scientifically  select  his  own  aids  and  antag- 

*  The  precise  formulae  of  the  three  solutions  are  as  follows: 


I. 

II. 

III. 

parts. 

parts. 

parts. 

Cocaine  hydrochloride, 

0.2 

0.1 

0.01 

Morphine  hydrochloride, 

0.025 

0.025 

0.005 

Sodium  chloride, 

0.2 

0.2 

0.2 

Phenol  (5  per  cent.), 

0.30 

0.30 

0.30 

Distilled  water  (sterilized), 

100.00 

100.00 

100.00 

174  ANESTHETICS— LOCAL  AXALGESICS 

onists  to  the  drug.  This  impHes  a  knowledge,  on  his  part,  of  the  physio- 
logic action  of  the  various  drugs  proposed,  and  the  ability  to  note  the 
indications  for  the  selection  of  one  or  another  in  a  given  case.  And  this 
is  not  too  much  to  expect  of  the  trained  practitioner  of  today. 

As  a  type  of  combination  that  will  be  found  generally  applicable,  the 
following  is  suggested: 


I^. — Cocaine  hj-drochloridi 

Atropinae  sulpha tis 
Stn'chninae  sulphatis    . 
Phenolis       .... 

Gm.  or  mil. 

16 

008 

03 

12 

(gr.  iiss) 
(gr.l) 
(gr.  ss) 
(1Uij) 

Aquse  destillatse 

q.  s.  ad     15 

(fSss)— M. 

The  cocaine  strength  of  this  solution  wall  be  1  per  cent.,  and  each 
15  minims  will  contain  I  grain,  with  yYo  grain  of  atropine,  and  g-^ 
grain  of  strychnine.  One  or  two  drops  of  adrenalin  solution  (1  :  1000) 
may  be  added,  if  desired,  to  each  quantity  of  injection.  The  carbolic 
acid  present  is  for  preservation.  Even  less  will  suffice  to  keep  the  solu- 
tion for  some  time. 

Prinz*  suggests  that  the  solution  should  be  made  isotonic  with  the 
blood,  so  as  to  preserve  normal  cell  osmosis,  which  is  doubtless  an  advan- 
tage in  the  matter  of  lessening  the  irritation  caused  by  the  solution. 
He  states  that  to  make  a  1  per  cent,  solution  of  cocaine  isotonic  requires 
the  addition  of  0.8  per  cent,  of  sodium  chloride,  making  the  following 

proportions : 

Cocaine  hydrochloride,  5  grains 

Sodium  chloride,  4 

Sterile  water,  1  fluidounce. 

To  each  syringeful  (30  minims)  he  adds  2  drops  of  adrenalin  choride 
solution  when  used. 

General  Action  of  Cocaine. — Plates  II  and  III  are  intended  to  illus- 
trate the  action  of  the  drug  upon  the  different  parts  of  the  system. 

General  Uses.— Cocaine  has  come  to  be  relied  upon  for  the  relief  of 
pain  and  irritation  wherever  it  can  be  locally  applied.  Its  local  anal- 
gesic action  renders  it  of  great  value  in  minor  surgery,  and,  properly 
adapted,  it  is  useful  for  operations  of  considerable  extent.  A  t^-pical 
occasion  for  its  use  would  be  the  removal  of  a  foreign  body  from  the  eye. 
Here  the  instillation  of  a  few  drops  of  a  2  per  cent,  solution  will  quickly 
abolish  painful  sensation  and  lessen  reflex  sensibility  to  such  a  degree 
as  to  permit  of  easy  removal  of  a  foreign  body  even  from  the  cornea. 

*  Dental  Cosmos,  September,  1908,  p.  931. 


COXDUCTIVE  OR  REGIOXAL  AXESTHESIA  11  o 

■  Itching  in  various  parts  of  body  may  require  its  application,  either  in 
aqueous  solution  or  in  form  of  the  oleate.  Painful  conditions  in  the 
lower  part  of  the  bowel,  as  in  dysentery,  call  for  its  use  in  form  of 
suppository.  In  coryza  it  is  useful  in  form  of  solution  sprayed  or 
dropped  into  the  nostrils,  but  such  use  prolonged,  or  that  of  a  cocaine 
snujff,  presents  great  danger  of  habit  formation. 

Internally  it  may  be  of  use  in  persistent  vomiting  when  this  is  depend- 
ent upon  irritation  in  the  stomach.  Its  use  as  a  substitute  for  morphine 
in  habitual  use  of  the  latter  should  be  advised  against,  as  it  proves  no 
aid  in  overcoming  the  habit,  while  the  result  is  likely  to  be  the  con- 
tinuance of  both  drugs  or  substitution  of  cocaine  habit  for  morphine 
habit,  which  is  no  improvement. 

Earache,  when  not  relieved  by  warm  irrigation,  calls  for  the  appli- 
cation of  cocaine;  three  drops  of  a  3  or  4  per  cent,  solution  dropped  into 
the  ear  wiU  usually  suffice.  [A  |  grain  tablet  (0.015  gm.)  dissolved  in 
eight  drops  of  water,  one-half  used  and  repeated  if  needed.] 

Incompatibility. — Cocaine  hydrochloride  is  incompatible  with  alkalies 
and  alkaline  carbonates,  with  tannic  acid,  with  potassium  iodide,  and 
with  some  metallic  salts.  It  is  decomposed  by  2^0/0.5.5^^;/^  jpermanganate. 
With  solution  of  silver  nitrate  a  white  precipitate  of  chloride  of  silver 
occurs.  A  white  precipitate  occurs  with  a  solution  of  borax  or  with  a 
strong  solution  of  phenol. 

Aids  to  the  Action  of  Cocaine. — Other  agents  of  the  same  class,  that 
are  less  poisonous  and  sufficiently  soluble,  may  supplant  cocaine  or  be 
combined  with  it.  It  is  preferable,  in  the  interest  of  accuracy,  to  use 
the  drugs  separately;  so  that  mixtures  of  cocaine  with  its  substitutes 
need  not  be  considered.  For  prolonged  effect,  as  in  nerve  blocking, 
quinine  and  urea  hydrochloride  is  a  useful  addition,  but  it  is  injected 
separately.  If  there  is  an  open  wound  or  denuded  siu-face,  as  in  case  of 
a  burn,  cjrthoform  powder  is  useful.  Agents  that  lessen  the  blood  supply 
to  the  part,  as  cold  applications,  will  aid  slightly. 

The  use  of  adrenalin  or  other  suprarenal  products  as  an  aid  to  the 
action  of  cocaine  has  become  established.  The  claim  that  less  cocaine 
is  needed  when  so  combined  is  borne  out  in  the  experience  of  surgeons. 
Two  factors  in  its  action  serve  to  explain  its  value:  first,  it  contracts 
the  arterioles  locally,  thus  lessening  the  amount  of  blood  in  the  injected 
area;  and,  second,  it  lessens  the  activity  of  absorption  into  the  circu- 
lation beyond  the  locality. 

It  is  evident  that,  with  the  local  circulation  lessened  by  vasocon- 
striction, less  cocaine  is  likely  to  pass  into  the  circulation  in  a  given  time, 


176  ANESTHETICS— LOCAL  ANALGESICS 

which  means  that  more  remains  just  where  its  effect  is  wanted,  and  the 
danger  of  systemic  poisoning  is  lessened.  The  combination  is  easily 
made  by  adding,  to  the  solution  of  cocaine  hydrochloride  for  each 
injection,  several  drops  of  the  1  :  1000  adrenalin  chloride  solution. 
Reports  indicate  that  the  cocaine  strength  of  the  solution  can  be 
considerably  reduced.  One  series  of  100  operations,*  which  included 
resection  of  the  superior  maxilla,  removal  of  a  goitre  and  complete 
removal  of  the  larynx,  were  performed  under  the  use  of  a  solution 
consisting  of  9  parts  of  a  |  per  cent,  solution  of  cocaine  and  1  part  of 
adrenalin  (1  :  1000). 

If  the  part  to  be  operated  upon  admits  of  a  ligature  being  placed 
about  it,  the  entrance  of  cocaine  into  the  general  circulation  may  thus 
be  limited  and  its  local  effect  prolonged.  ■Morphine  has  no  local  analgesic 
action, t  therefore  it  is  without  value  as  an  aid  to  cocaine. 

Poisonous  Effects. — Antagonists. — Poisoning  by  cocaine  may  be  due  to 
a  weakened  condition  of  certain  organs  whereby  they  are  rendered  more 
susceptible  of  depression,  or  to  an  overdose  (see  Plate  III),  or  to  idio- 
syncrasy. The  symptoms  are  variable,  hence  cocaine  poisoning  presents 
no  distinct  picture.  ^Yhile  the  drug  has  the  power  to  first  stimulate  and 
later  depress  the  central  nervous  system,  depression  in  some  part  may 
occur  suddenly  with  irregularity  of  symptoms.  The  toxic  effects  may 
include : 

(a)  Depression  of  the  brain,  manifested  by  narcosis  or  spasm, 

(6)  Depression  of  the  medulla  and  spinal  cord,  as  shown  by  failure 
of  respiration  and  depression  of  vasomotor  and  reflex  activity. 

(c)  Direct  depression  of  the  heart,  which,  with  lessened  vasomotor 
control,  causes  a  marked  fall  of  arterial  pressure. 

The  most  serious  conditions,  then,  are  depression  of  heart,  ^'aso- 
motors  and  respiratory  center.  The  combined  result  of  these  is  to  lessen 
the  arterial  pressure  very  decidedly,  with  a  certain  degree  of  asphyxia 
added.  These  are  the  conditions  to  be  antagonized.  Therefore,  it 
appears  at  once  that  any  agent  that  does  not  either  stimulate  the 
vasomotor  system,  the  heart,  or  the  respiratory  center,  is  of  no  value. 
Nitrite  of  amyl  and  nitroglycerin  dilate  the  arterioles  by  depressing 
the  vasomotor  system;  they  do  not  stimulate  respiration  and  their 
direct  action  upon  the  heart  is  doubtful.  Therefore,  they  should  never 
be  used  to  antagonize  cocaine,  chiefly  because  they  will  still  further 

*  See  Gould's  Year  Book  of  Medicine  and  Surgery,  1905  (Medical  vol.),  p.  472. 
t  See  note  on  page  87. 


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CONDUCTIVE  OR  REGIONAL  ANESTHESIA  177 

reduce  the  arterial  pressure.*  Our  best  antagonists  will  be  those  that 
increase  arterial  pressure  by  stimulation  of  both  vasomotor  centers  and 
heart,  and  which  at  the  same  time  stimulate  the  respiratory  center. 
Three  agents  that  act  in  all  three  ways  are  caffeine,  strychnine  and 
atropine  (see  Plate  IV).  Caffeine  has  a  dose  of  1  to  5  grains  (0.06-0.30 
gm.)  and  is  soluble  in  not  less  than  25  parts  of  water ;t  therefore  it 
would  be  an  impracticable  substance  to  include  in  a  cocaine  solution. 
The  proper  salt  of  caffeine  for  hypodermic  use  is  the  official  caffeine 
sodio-benzoate,  soluble  in  1.1  parts  of  water,  dose  3  to  5  grains  (0.20- 
0.30  gm.).  The  dose  of  strychnine  sulphate  is  -^q-  to  y^  of  ^  grain 
(0.001-0.006  gm.)  and  of  atropine  sulphate  y^Q-  to  -^-^  of  a  grain  (0.005- 
0.001  gm.),  and  both  are  sufficiently  soluble  so  that  they  may  be  com- 
bined in  the  same  solution  with  cocaine.  The  dose  for  injection  at  one 
sitting  should  not  exceed  |  grain  of  cocaine  hydrochloride,  y^o"  of  atropine 
sulphate,  and  -^q^  of  strychnine  sulphate;  then  in  case  of  danger  symp- 
toms from  the  cocaine  the  other  drugs  may  be  repeated  in  the  same  dose, 
but  the  atropine  sulphate  not  more  than  once.  It  is  well  to  have  at  hand 
separate  hypodermic  tablets  of  these  drugs  in  the  doses  mentioned,  not 
for  routine  administration  in  every  case,  but  for  use  according  to  the 
operator's  judgment.  It  would  be  unwise  to  depend  upon  these  in  order 
to  exceed  the  safe  dose  of  cocaine,  but  in  persons  known  to  be  susceptible 
to  its  depressant  action,  or  where  such  susceptibility  is  feared,  it  is  proper 
to  employ  these  antagonists  in  advance  of  the  injection  of  cocaine. 

When  poisoning  occurs  unexpectedly  we  may  use  the  remedies 
mentioned  above  for  the  purpose  of  stimulating  the  whole  central 
nervous  system,  in  order  to  induce  activity  of  cerebral  functions,  of 
respiration,  and  of  circulation.  Plate  IV  illustrates  the  action  of  these 
and  of  digitalis,  which  also  is  indicated  if  the  circulatory  failure  is  at  all 
persistent.  In  this  emergency  fSi"!  (1-4  mils)  of  tincture  of  digitalis 
may  be  given  hypodermically.    But  it  must  be  remembered  that  digi- 

*  Nitroglycerin  has  been  mentioned  as  an  antagonist  to  cocaine,  but  it  is  contra- 
indicated  when  blood-pressure  is  low.  If  there  is  much  depression  of  the  circulation 
it  may  do  harm  by  further  reducing  blood-pressure.  It  is  doubtful  whether  nitro- 
glycerin has  any  direct  stimulant  action  upon  the  heart.     (See  Plate  XIII.) 

t  Caffeine  in  its  simple  form  is  soluble  in  46  parts  of  water  and  66  parts  of  alcohol 
at  25°  C.  (77°  F.),  but  the  addition  of  benzoate  or  saUcylate  of  sodium  renders  it 
very  soluble  in  water.  Thus  Caffeine-sodium  salicylate  is  soluble  in  2  parts  of  water 
and  caffeine-sodium  benzoate  in  1.1  parts.  Either  may  be  used  hypodermically  in 
dose  of  3  to  5  grains  (0.20-0.30  Gm.). 

Citrated  caffeine  forms  a  clear,  syrupy  liquid  with  about  4  parts  of  hot  water. 
Upon  dilution  with  water,  this  yields  a  white  precipitate  (caffeine),  which  redissolves 
when  about  25  parts  of  water  have  been  added. 
12 


178  ANESTHETICS— LOCAL  ANALGESICS 

talis  is  a  slowly  acting  drug  and  cannot  be  relied  upon  alone  for  sudden 
emergencies. 

Adrenalin  is  among  the  most  useful  of  agents  for  stimulating  a 
depressed  circulation.  It  acts  both  by  direct  stimulation  of  the  heart 
and  by  constriction  of  arterioles,  causing  a  decided  rise  of  arterial  blood- 
pressure.  The  disadvantage  of  uncertainty  of  action,  unless  employed 
intravenously,  lessens  its  practical  value  in  emergency  cases.  It  gives 
no  result  when  administered  by  the  stomach  and  very  little  when 
injected  h^-podermically  in  ordinary  quantities;  but  its  use  by  the  latter 
method  may  be  resorted  to  in  emergency,  1  to  5  mils  of  the  1  :  1000 
solution,  diluted  with  ten  times  as  much  normal  saline  solution,  being 
employed.  Another  of  our  most  efficient  circulatory  stimulants  is  cam- 
phor, dissolved  in  oil,  given  hypodermically.  The  dose  is  gr.  1  to  5 
(0.06-0.30  gm.). 

Immediate  stimulation  of  both  respiration  and  circulation  should  be 
secured  also  by  administering,  and  applying  to  the  air  passages,  some 
of  the  irritant  agents  that  stimulate  reflex  activity  by  irritating  sensory 
nerve  endings.  The  chief  preparations  that  act  in  this  way  are  water 
of  ammonia  and  spirit  of  camphor  by  inhalation;  and  for  administration 
by  the  stomach,  aromatic  spirit  of  ammonia  or  alcohol,  each  in  dose  of 
15  to  60  minims  diluted  with  as  much  water.  If  necessary,  repeat  the 
dose  of  any  in  ten  or  fifteen  minutes. 

The  fact  holds  that  these  agents  are  useful  mainly  by  reason  of  their 
irritant  action.  They  should,  therefore,  be  given  without  much  dilution, 
so  that  their  effect  upon  sensory  nerve-endings  in  the  mouth,  throat, 
esophagus  and  stomach  may  be  decided,  and  the  consequent  reflex 
stimulation  of  heart  and  respiratory  center  be  efficient.  Irritation  of 
the  skin  by  friction,  slapping  or  faradism  will  act  in  the  same  way. 

If  there  be  considerable  depression  of  the  respiration,  as  shown  by 
slow  or  weak  movements  of  the  chest  or  by  cyanosis,  artificial  respiration 
should  be  resorted  to  in  order  to  secure  proper  oxygenation  of  the  blood. 
(See  Artificial  Respiration.)  In  connection  therewith  massage  of  the 
heart  by  an  assistant,  by  pressure  between  diaphragm  and  chest  wall 
particularly  with  the  movement  of  expiration,  has  come  to  be  employed 
as  an  important  aid  in  reestablishing  the  heart's  efficiency.  It  is  most 
effectual  in  cases  where  the  irritability  of  the  heart  muscle  is  not  much 
impaired. 

Substitutes  for  Cocaine. — The  following  list  comprises  the  chief  drugs 
that  have  been  substituted  for  cocaine  from  time  to  time,  some  of  which 
have  been  found  wanting  in  essential  qualities,  some  are  still  under 


CONDUCTIVE  OR  REGIONAL  ANESTHESIA  179 

trial,  while  others  answer  the  purpose  in  varying  degree.  It  is  evident 
that  any  agent,  in  order  to  be  entitled  to  consideration,  must  compare 
favorably  with  cocaine  not  only  as  to  efficiency,  but  in  addition  must 
be  less  toxic,  or  its  solutions  must  keep  better,  or  it  must  possess  some 
other  decided  advantage. 

Alypin.  Beta-eucaine.  Novocaine.  Tropacocaine. 

Apothesin.  Nirvanin.  Stovaine. 

The  two  following  are  used  for  a  slower  and  more  prolonged  effect: 
Orthoform.  Quinine  and  Urea  Hydrochloride. 

These  drugs  are  mostly  alkaloidal  in  nature  and,  therefore,  used 
largely  in  form  of  a  soluble  salt.  Their  properties  will  be  noted  briefly  and 
comparisons  of  their  efficiency  and  adaptability  given  in  tabular  form. 

Alypin  (not  official). — This  name  is  usually  applied  to  ah-pin  hydro- 
chloride, though  the  nitrate  also  is  upon  the  market.  As  experiments 
have  shown  alypin  to  be  fully  as  poisonous  as  cocaine  (see  pp.  182-183), 
it  is  destined  to  be  discarded  as  a  substitute.  Its  only  place  would 
seem  to  be  in  form  of  the  nitrate  when  it  is  desirable  to  use  a  local 
analgesic  in  combination  with  silver  nitrate,  with  which  any  soluble 
chloride  would  be  incompatible.  Alypin  is  freely  soluble  in  water  and 
in  alcohol. 

Apothesin  (not  official) . — This  is  one  of  the  newer  synthetics  for  which 
important  advantages  are  claimed,  but  the  experiments  of  Sollmann 
seem  to  place  it  low  in  the  scale  of  efficiency.  (See  pp.  182-183.)  How- 
ever, many  practitioners  have  found  it  valuable. 

Beta-eucaine  Hydrochloride  is  a  white,  crystalline,  odorless  powder, 
soluble  in  30  parts  of  water  and  in  35  parts  of  alcohol.  It  is  about  one- 
half  as  efficient  as  cocaine  and  about  two-fifths  as  toxic.  Its  solutions 
keep  well.  It  is  more  irritating  than  cocaine  and  it  combines  less  effi- 
ciently with  suprarenal  preparations,  as  it  does  not  constrict  arterioles, 
but  rather  causes  h^-peremia.  It  ranks  as  a  fair  substitute  for  cocaine 
in  from  2  to  5  per  cent,  solutions,  either  for  direct  application  to  mucous 
membranes  or  for  hj^Dodermic  use.  In  1  per  cent,  strength  it  may  be 
substituted  for  cocaine  in  the  solutions  for  infiltration  anesthesia. 

Nirvanin  (not  official). — This  occurs  in  crystalline  or  powder  form, 
soluble  in  water  and  in  alcohol,  the  aqueous  solution  being  neutral  and 
claimed  to  be  germicidal  in  1  per  cent,  strength.  It  is  used  in  from  1  to  5 
per  cent,  solutions,  though  it  should  be  used  with  care,  as  it  is  reported 
to  be  seven-tenths  as  toxic  as  cocaine. 


180  ANESTHETICS— LOCAL  ANALGESICS 

Novocaine  (U.S. P.,  Part  II  [C13H20O2X2.HCI]). — This  drug  has  proved 
to  be  of  such  vakie  as  a  local  analgesic  and  substitute  for  cocaine  as  to 
merit  a  more  extended  description.  It  was  discovered  by  Einhorn  in 
1905.  It  is  a  white  powder,  soluble  in  1  part  of  water,  the  solution 
being  neutral  in  reaction;  soluble  also  in  30  parts  of  alcohol.  A  10  per 
cent,  aqueous  solution  is  neidral  to  litmus.  The  aqueous  solution,  as 
usually  employed,  may  be  heated  to  the  boiling-point  without  decom- 
position. It  has  the  advantage  of  being  non-irritating,  since  a  solution 
of  any  strength,  or  even  the  powder,  may  be  applied  to  the  conjunctiva. 
It  acts  efficiently  with  suprarenal  preparations,  the  effect  being  increased 
by  the  combination.  Novocaine  possesses  the  same  action  upon  the 
peripheral  sensory  nerves  as  does  cocaine,  when  directly  applied  to  the 
nerve.  The  same  is  true  of  its  use  by  injection  and  infiltration.  However, 
by  surface  application,  as  to  the  cornea,  its  action  is  very  much  weaker 
than  that  of  cocaine,  but  may  be  increased  somewhat  by  the  addition 
of  sodium  bocarbonate,  according  to  Gros.* 

Since  novocaine  is  only  one-half  as  toxic  as  cocaine,  it  may  be  used 
more  freely,  although  the  systemic  effects  of  large  doses  are  essentially 
the  same  as  those  of  cocaine;  but  when  used  in  the  ordinary  dosage 
there  are  no  systemic  effects.  Five  thousand  injections  in  the  extraction 
clinic  of  the  Dental  School  of  the  University  of  Buffalo,  using  a  2  per 
cent,  solution  in  normal  saline,  with  small  adrenalin  dosage,  have  shown 
no  systemic  reaction  in  a  single  case,  the  ages  ranging  from  childhood 
to  old  age. 

Prinzf  regards  novocaine  as  the  only  one  of  these  substances  that 
meets  the  demands  of  substitution  for  cocaine.  He  cites  evidence  that 
its  combination  with  adrenalin  increases  the  efficiency  of  both  drugs 
in  their  local  action.  He  prefers  a  2  per  cent,  solution  and  suggests  the 
following : 

Novocaine,  10  grains 

Sodium  chloride,  4    ' " 

Distilled  water,  1  fluidounce. 

Boil.     To  each  syringeful  (30  minims)  add  2  drops  of  adrenalin  chloride  solution 
when  used. 

Incompatibility. — Novocain  in  solution  is  incompatible  with  solution 
of  mercuric  chloride  and  with  solution  of  iodine,  a  precipitate  occurring 
with  each.  Mixed  with  calomel  in  equal  parts,  the  mixture  blackens 
when  moistened  with  diluted  alcohol.     [It  is  not  precipitated  by  borax 

*  Jour.  Am.  Med.  Assn.,  January  26,  1918,  p.  218. 
t  Dental  Cosmos,  September,  1908,  p.  932. 


CONDUCTIVE  OR  REGIONAL  ANESTHESIA  181 

nor  by  potassium  iodide,  as  are  cocaine  hydrochloride,  alypin  and 
stovaine.] 

Stovaine  (not  official)  .—Occui-s  in  small  scales,  soluble  in  2  parts  of 
water  and  readily  in  alcohol.  It  is  two-thirds  as  toxic  as  cocaine,  but 
much  more  irritating.  In  recent  years  it  has  been  brou^^ht  into  promi- 
nence through  its  use  in  spinal  anesthesia. 

Tropacocaine  (not  official)  .^An  alkaloid  from  the  leaves  of  Java  coca, 
prepared  also  synthetically.  It  occurs  in  colorless  crystals,  soluble  in 
water.  It  ranks  well  in  efficiency,  is  one-half  as  toxic  as  cocaine,  but  is 
more  irritating.  It  has  the  disadvantage  of  not  acting  efficiently  with 
suprarenal  preparations,  since  it  destroys  the  vasoconstrictor  action 
of  the  latter. 

Orthoform  (U.S.P.,  Part  II  [CgHgOaN]).— A  white,  tasteless  powder, 
sparingly  soluble  in  water,  but  soluble  in  about  5  parts  of  alcohol  and  in 
50  parts  of  ether;  also  soluble  in  sodium  hydroxide  solution.  This  drug 
is  non-toxic  in  usual  dosage,  and,  on  account  of  its  slight  solubility  in 
water,  it  has  practically  no  penetrating  power,  therefore  is  useful  only 
for  surface  action.  It  is  not  a  substitute  for  cocaine  in  the  usual  use  of 
the  latter  by  injection,  but  it  holds  an  important  place  for  prolonged 
surface  action,  as  in  painful  ulcers  and,  in  dentistry,  applied  to  a  painful 
tooth  socket  after  extraction.  After  operations  upon  the  mouth  or 
throat  its  application  in  powder  form  will  greatly  lessen  the  pain  of 
movement  or  friction.  It  has  been  used  internally  to  relieve  the  pain 
of  gastric  ulcer,  the  internal  dose  being  from  2  to  15  grains  (0.12-1  Gm.). 
Used  in  tablet  form  to  be  slowly  dissolved  in  the  mouth,  it  will  often  give 
much  relief  in  cases  of  sore-throat.  The  hydrochloride  of  orthoforvi*  is 
said  to  be  soluble  in  10  parts  of  water,  the  solution  being  acid  in  reaction, 
and  having  the  same  action,  dosage  and  uses  as  orthoform. 

Incompatibility. — Orthoform  is  generally  used  alone.  It  is  incom- 
patible with  silver  nitrate,  potassium  permanganate  and  with  zinc  chloride. 

Quinine  and  Urea  Hydrochloride  occurs  in  colorless  crystals  or  as  a 
white  granular  powder,  odorless  and  bitter  to  the  taste.  It  is  soluble 
in  0.9  part  of  water  and  in  2.4  parts  of  alcohol.  The  aqueous  solution 
is  acid  in  reaction.  This  agent  is  comparatively  non-toxic,  the  internal 
dose  being  15  grains  (1  Gm.).  It  is  about  one-fourth  as  efficient  as 
cocaine  when  injected  into  the  tissues;  however,  it  has  the  unique 
advantage  of  producing  a  more  lasting  effect — from  several  hours  to 
several  days.    Accordingly,  it  is  often  used  for  continued  effect,  in  con- 

*  National  Dispensatory,  3d  ed.,  p.  1020. 


182  ANESTHETICS— LOCAL  ANALGESICS 

nection  with  a  more  powerful  analgesic,  in  order  that  the  pain  after 
operation  may  be  lessened  and  the  use  of  opiates  averted.  A  1  per  cent, 
solution  is  commonly  employed. 

Comparisons   of   Cocaine   and   its   Substitutes. — The   essential 
requirements  of  a  satisfactory  substitute  for  cocaine  are  as  follows: 

1.  It  should  be  less  toxic  than  cocaine. 

2.  It  should  be  soluble  in  water. 

3.  It  should  not  be  irritating  to  the  tissues. 

4.  It  should  be  compatible  with  suprarenal  preparations. 

5.  It  should  admit  of  sterilization  by  boiling. 

1-2. — Four  of  the  drugs  described  fulfil  conditions  one  and  ttvo,  viz.: 
Stovaine. 
Xovocaine. 
Tropococaine. 
Beta-eucaine. 

3.  A  comparison  in  regard  to  the  third  condition  shows  the  following 
results  when  injected  subcutaneously  into  the  abdomen  of  the  rabbit.* 

Cocaine. — Swelling  and  hyperemia  soon  after  injection,  with  complete 
return  of  the  area  to  normal. 

Stovaine. — Intense  hyperemia,  dilatation  of  bloodvessels  followed  by 
sloughing. 

Beta-eucaine. — Swelling  about  the  site  followed  by  sloughing. 

Tropococaine. — wSwelling  followed  by  sloughing. 

Xovocaine. — Xo  swelling,  no  hyperemia,  part  normal  after  injection 
and  remained  so. 

4-5. — Xovocaine  also  fulfills  conditions  four  and  five  and  thus  is  the 
only  one  of  the  substitutes  which  fulfills  all  of  the  essential  require- 
ments for  a  local  anesthetic.  Indeed  it  may  be  said  that  this  drug  is 
an  ideal  local  anesthetic  for  use  in  dentistry. 

Toxicity. — The  following  comparative  table  of  toxicity  of  cocaine 
and  its  substitutes  is  of  interest.  It  is  based  upon  the  minimum  quanti- 
ties causing  death  in  frogs,  mice  and  rabbits,  the  drugs  being  named  in 
the  order  of  their  toxic  effects. f 

Frogs.  Mice.  Rabbits. 

Alypin.  Alypin.  Alypin. 

Cocaine.  Cocaine.  Cocaine. 

Stovaine.  Nirvanin.  Stovaine. 

Nirvanin.  Stovaine.  Tropococaine. 

Beta-eucaine  Lactate.  Novocaine.  Novocaine. 

Tropococaine.  Tropococaine.  Beta-eucaine  Lactate. 

Novocaine.  Beta-eucaine  Lactate. 

*  Le  Brocq,  British  Med.  Jour.,  March  27,  1909,  p.  783.  t  Ibid. 


COXDUCTIVE  OR  REGIOXAL  AXESTHESIA  1S3 

Taking  the  action  on  mammals  into  consideration,  i.  e.,  paralysis 
of  nerve  centers  (including  respiratory;  the  following  results  have  been 
shown : 

Toxicity  of  cocaine  is  1  00 

ah-pin  is  1 .  25 

nirvanin  is  0  714 

stovaine  is  0  625 

tropococaine  is      0  500 
novocaine  is  0  490 

beta-eucaine  is      0  414 
Efficiexcy. — Solhnami*  has  investigated  local  analgesics  in  reference 
to  their  efficiency  both  by  surface  application  and  by  injection  into  the 
tissues.     The  practical  results  of  his  observations  may  be  thus  tabu- 
lated, sho-^-ing  the  ratio  of  efficiency  with  cocaine  as  the  unit : 

Analgesic  Effect  upon  Sensory  Serves  Compared. 

By  surface  application  (to  cornea) .  By  intracutaneous  use  finfiltration  and 

Ratio.  injection) .  Ratio. 

Cocaine  hydro cKLoride    ...  1  Cocaine  hydrochloride                        1 

Beta-eucaine  hydrochloride       .  |  Xovocaine  hydrochloride                    '       j 

Tropococaine  ]  Tropococaine  hydrochloride      .      .  | 

Al\"pin  }       i  Al}.-pin  hydrochloride                          ' 

Quinine  and  urea  hycbochloride  Beta-eucaine  hydrochloride       .      .  | 

Apothesin  hydrochloride      .      .  f  Quinine  and  urea  hydrochloride      .         | 

Xovocaine  hydrochloride     .      .  it       Apothesin i 


A  fact  worthy  of  note  in  the  above  comparison  is  the  very  low  effi- 
ciency of  novocaine  when  applied  upon  the  siu^ace  to  the  cornea), 
as  compared  with  its  high  efficiency  when  injected.  It  was  found,  how- 
ever, that  the  addition  of  sodium  bicarbonate  increased  the  efficiency 
of  novocaine,  as  also  of  the  other  agents,  for  siu-face  effect.  To  state 
the  matter  definitely:  If  the  anesthetic  is  made  up  "in  double  concen- 
tration, and  diluted,  just  before  use,  with  an  equal  volume  of  0 .5  per 
cent,  sodium  bicarbonate  solution,  this  increases  the  efficiency  (for  the 
cornea)  as  follows:  Cocaine,  from  one  to  two  times;  beta-eucaine.  two 
times;  novocaine,  from  two  to  foiu*  times;  tropococaine  or  ah"pLn,  four 
times."  It  must  he  emphasized  that  this  result  does  not  obtain  with  injec- 
tion or  infiltration  uses  of  the  drugs,  but  only  with  surface  application. 
Another  point  arrived  at  by  SoUmannf  is  that  the  suprarenal  prepara- 
tions, combined  with  the  local  anesthetic,  while  very  valuable  to  pro- 
long the  period  of  anesthesia  when  the  mixtiue  is  injected  into  the  tis- 

*  Jour.  Am.  Med.  Assn.,  .January-  28,  1918,  p.  216.  t  Ibid. 


184  ANESTHETICS— LOCAL  ANALGESICS 

sues,  is  useless  for  surface  application — in  fact,  "  it  rather  diminishes 
the  penetration  and  therefore  the  efficiency  of  the  anesthetics  on  mucous 
membranes  (cornea) . ' ' 

Spinal  Cocainization. — Among  the  methods  of  inducing  analgesia, 
that  of  injecting  a  solution  of  cocaine  (0.2  to  0.5  per  cent,  strength)  into 
the  spinal  canal  has  been  employed,  having  been  first  advocated  by 
Dr.  Corning,  of  New  York.  By  this  means  all  parts  of  the  body  below 
the  point  of  injection  may  have  sensation  to  pain  abolished,  so  that 
it  is  possible  to  do  even  an  extensive  surgical  operation  by  aid  of  this 
method. 

There  are  dangers  attending  this  procedure,  and  its  limitations  have 
become  recognized.  When  employed,  the  injection  should  be  made 
as  low  down  as  possible,  so  as  to  avoid  the  efi"ect  of  the  drug  upon 
the  medulla.  The  method  for  the  present  should  be  used  only  in  those 
cases  where  a  general  anesthetic  is  contra-indicated,  and  where  the  site 
of  injection  may  be  at  a  point  some  distance  from  the  medulla. 


PAET  III. 
GENERAL  REMEDIES. 


CHAPTER  XIV. 
ANESTHETICS. 

A  TOPIC  of  so  great  importance  as  that  of  general  anesthesia  merits 
brief  historical  references  as  to  agents  employed  and  their  discoverers.* 
Ethylic  ether,  formerly  called  "sulphuric  ether,"  and,  still  earlier, 
"sweet  oil  of  vitriol,"  was  known  as  early  as  the  thuteenth  century,  but 
the  name  of  its  discoverer  is  unknown.  While  it  was  used  for  some 
medicinal  purposes  in  the  eighteenth  century  and  probably  earlier,  and 
although  its  intoxicating  and  narcotic  properties  had  been  discovered, 
it  was  not  employed  for  practical  anesthesia  until  1842.  During  several 
years  it  was  put  to  successful  practical  tests  by  Crawford  Long,  of 
Georgia,  by  Horace  Wells,  of  Vermont,  and  by  W'illiam  T.  G.  Morton, 
of  Boston,  the  last-named  having  demonstrated  its  use  in  a  public  way 
in  Dr.  Warren's  clinic  at  the  Massachusetts  General  Hospital,  October 
16,  1846. 

With  the  discovery  of  chloroform  four  names  must  be  associated: 
Guthrie,  of  Sackett's  Harbor,  N.  Y.,  who  is  credited  with  its  first  dis- 
covery (1831);  Liebig,  of  Germany,  and  Soubeiran,  of  France,  who  were 
close  contemporaries  with  Guthrie  in  its  recognition,  and  Dumas,  who 
made  known  its  composition  in  1835  and  gave  it  its  present  name.  In 
1847  it  was  introduced  as  an  anesthetic  by  Simpson,  of  Great  Britain, 
a  physician  of  great  prominence,  who  at  once  began  to  use  it  extensively 
in  his  practice. 

Nitrous  oxide  also  was  known  for  many  years  before  it  came  to  be 
practically  applied  as  an  anesthetic.  It  was  first  obtained  by  Priestly 
in  1772.  In  1799  Humphry  Davy,  of  England,  observed  the  exhilarating 
and  intoxicating  effects  caused  by  inhaling  this  gas,  and  published  his 

*  For  a  fuller  discussion  of  the  history  of  anesthesia,  see  Park's  Epitome  of  the 
History  of  Medicine. 


186  AXESTHETICS 

investigations  in  ISOO.  The  credit  for  its  first  use  as  a  surgical  anesthetic 
belongs  to  Horace  Wells,  who  employed  it  in  1844  for  the  extraction  of  a 
tooth. 

The  condition  of  general  anesthesia  must  include  more  than  the 
abolition  of  consciousness  to  pain,  the  removal  of  unconscious  muscular 
activity  being  only  secondary  in  importance.  In  many  cases  a  compara- 
ti\-ely  small  amount  of  an  anesthetic  will  suffice  to  abolish  consciousness 
of  pain,  but  muscular  rigidity  or  activity  will  prevent  the  performance  of 
a  surgical  operation.  The  term  partial  anesthesia  is  sometimes  applied  to 
a  grade  of  effect  where  the  cerebrum  is  paralyzed,  with  loss  of  conscious 
sensation,  but  where  the  reflex  centers  of  the  spinal  cord  are  still  sensitive, 
as  shown  by  muscular  activity  whenever  sensory  nerves  are  irritated. 

In  studying  these  agents  we  also  recognize  the  possibility  of  securing 
a  purely  analgesic  effect  from  smaller  quantities  than  are  required  for 
anesthesia.  This  is  particularly  true  of  nitrous  oxide,  as  will  be  shown 
later. 

As  a  class  the  t>i)ical  anesthetics  are  peculiar  in  respect  to  the  order 
in  which  the\'  paralyze  the  different  parts  of  the  nervous  system.  At 
first  thought  the  production  of  complete  paralysis  of  all  parts  of  the  body 
capable  of  responding  to  external  stimuli,  by  the  administration  of  a 
substance  foreign  to  the  body,  would  seem  to  be  an  extremely  dangerous 
procedure;  and  so  it  appeared  until  it  was  ascertained  that  the  paralysis 
was  induced  in  such  order  that  the  centers  of  consciousness  were 
affected  first  and  those  whose  activity  is  absolutely  essential  to  life  last. 
Any  agent,  therefore,  to  rank  safely  among  this  class  of  drugs  must 
conform  in  action  strictly  to  the  lines  of  safety  which  have  now  become 
well  established.  Plate  V.  presents  a  division  of  the  central  nervous 
system  into  sections,  which  are  nmnbered  in  the  order  in  which  they  are 
paralyzed  by  anesthetics.  It  will  be  seen  that  the  most  highly  developed, 
or  differentiated,  nerve  tissue  (brain)  is  first  affected,  while  the  simpler 
and  more  vital  structures  that  are  common  to  all  forms  of  animal 
existence  (those  connected  with  the  functions  of  respiration  and  circu- 
lation) a^e  affected  later,  being  apparently  more  resistant  to  the  influence 
of  the  drugs  of  this  class. 

It  is  remarkable  that  these  century-old  agents  have  never  been  sup- 
planted by  newer  anesthetics.  The  past  few  decades,  that  ha\e  yielded 
so  much  in  the  way  of  synthetic  drugs,  have  not  given  us  new  general 
anesthetics,  but  have  been  devoted  to  a  closer  study  of  the  old,  as  to  their 
precise  action,  their  dangers,  and  better  methods  of  administration. 
That  this  has  been  a  fruitful  study  is  evidenced,  among  other  things, 


PLATE     V. 


Danger  area 


Anesthesia  area 

Consciousness  abolished 


3,  Mespiration  paralyzed 


4,  Circulation  paralyzed 


The  several  sections  are  numbered  in  the 
order  in  which  they  are  paralyzed  by  anes- 
thetics. The  paralysis  of  1  and  2  constitutes 
surgical  anesthesia,  paralysis  of  3  introduces 
an  element  of  great  danger,  and  that  of  4  is 
usually  fatal. 

[The  heart  is  included  in  this  diagram  of 
the  several  parts  of  the  central  nervous  sys- 
tem, for  the  reason  that  it  contains  nerve- 
ganglia,  which,  with  their  highly  ii'ritable 
muscular  structure,  provides  for  its  auto- 
matic, rhythmic  action.  This  provision  is 
quite  independent  of  the  cerebrospinal  sys- 
tem.] 


2.  Keflex  activity  abolished 


MODE  OF  ACTION  OF  ANESTHETICS  187 

by  the  adaptation  of  nitrous  oxide  to  the  field  of  general  surgery,  where 
it  is  now  used  so  largely  with  satisfaction  and  safety.  Another  result  is 
that  the  science  of  anesthetics  has  been  so  developed  that  now  very  few 
cases  occur  that  cannot  be  safely  anesthetized  by  an  expert  using  the 
proper  agent.  It  may  be  added  also  that  the  judicious  use  of  other 
narcotics  with  the  anesthetic,  in  order  to  render  the  narcosis  more  pro- 
found and  to  lessen  shock,  has  become  more  and  more  a  routine  practice. 
This  is  particularly  true  of  the  hypodermic  use  of  morphine  (sometimes 
with  scopolamine)  preliminary  to  prolonged  nitrous-oxide-oxygen  anes- 
thesia. 

Mode  of  Action  of  Anesthetics. — ^\'arious  theories  have  from  time  to 
time  been  proposed  to  explain  the  mode  of  action  of  anesthetics,  by 
ascribing  their  effects  to  action  upon  the  blood,  to  alteration  of  the 
circulation  within  the  brain,  and  to  asphyxia;  but  the  present  belief  is 
that  these  substances  produce  their  effects  chiefly  by  a  direct  action 
upon  the  nerve  centers. 

As  to  the  precise  action  of  the  anesthetic  upon  nerve  cells,  it  has 
been  observed  that  the  volatile  liquid  anesthetics  are  fat  solvents;  and 
the  investigations  of  Meyer  and  Overton  led  them,  independently,  to 
the  conclusion  that  anesthesia  is  caused  by  the  solution  of  the  lipoid 
constituents  of  the  cells  by  the  absorbed  anesthetic  vapor.  The  fact 
of  the  transient  influence  accords  with  a  belief  in  some  such  simple 
physical  change  as  solution,  which  would  obtain  only  while  the  vapor 
was  present  in  sufficient  quantity.  This  theory  could  hardly  explain 
the  action  of  nitrous  oxide,  a  gas  whose  nature  and  properties  differ  so 
greatly  from  those  of  the  other  anesthetics.  If  a  common  action  is  to 
be  found  it  must  rest  upon  other  facts. 

Blood  Changes  Induced  by  Anesthetics. — A  number  of  observers  have 
studied  the  blood  in  reference  to  anesthesia  and  some  positive  conclusions 
have  been  set  forth  as  to  changes  in  the  blood  caused  by  anesthetics. 

Ui^on  Hemoglobin. — It  is  now  generally  recognized  that  the  hemo- 
globin of  the  blood  is  diminished  in  varying  degrees  by  these  agents 
(by  ether  markedly  and  rapidly,  by  nitrous  oxide  slightly  and  transiently) 
and  that  any  case  having  less  than  60  per  cent,  of  hemoglobin  would  be 
hazardous  under  ether,  and  probably  under  chloroform,  which  increases 
hemolysis  as  well. 

Upon  Blood  Cells. — Casto,*  in  observations  upon  eight  human  sub- 
jects, found  that:     "The  general  tendency  of  the  erythrocytes  was  to 

*  Am.  Year  Book  of  Anesthesia  and  Analgesia,  1915. 


188  ANESTHETICS 

decrease  during  anesthesia,  an  average  loss  of  IG  per  cent,  resulting  from 
the  cases  studied."  These  results  were  confirmed  in  the  main  by  experi- 
ments upon  animals. 

Upon  Alkalinity  of  the  Blood. — Acid  products  are  increased  in  the 
tissues  and  blood  during  anesthesia,  chiefly  because  of  diminished  oxida- 
tion. In  prolonged  anesthesia  this  may  reduce  the  alkalinity  of  the 
blood  to  a  serious  degree.  When  there  is  muscular  activity  during  par- 
tial anesthesia  the  natural  production  of  acid  is  increased,  and  if  cyanosis 
is  present,  indicating  a  great  diminution  of  oxygen  intake,  the  acidosis 
may  be  a  factor  of  great  danger,  not  simply  during  anesthesia,  but 
afterward.  Hemorrhage  increases  this  danger,  because  a  diminished 
circulation  brings  less  oxygen  to  burn  up  the  accumulated  acid  products. 
Thus,  acidosis  (or  high  concentration  of  hydrogen  ions*)  probably  is 
the  important  factor  in  auto-intoxication  that  often  follows  surgical 
anesthesia,  and  which  must  be  distinguished  from  surgical  shock. 

Upon  Blood-pressure. — The  tendency  is  for  blood-pressure  to  diminish 
during  anesthesia  that  is  at  all  prolonged,  but  the  effect  varies  according 
to  the  agent  employed;  with  chloroform  the  fall  usually  begins  by  the 
end  of  fifteen  minutes  and  rapidly  reaches  its  minimum  within  a  few 
minutes;  with  ether  the  fall  does  not  usually  begin  under  twenty  minutes 
and  is  then  very  gradual,  often  continuing  and  reaching  its  minimum 
after  the  operation  has  been  completed  and  the  anesthetic  removed; 
with  nitrous-oxide-oxygen  no  change  in  blood-pressure  attributable  to 
the  anesthetic  is  seen  within  two  hours,  and  any  fall  occurring  after 
longer  administration  has  been  found  to  disappear  promptly  upon 
removing  the  anesthetic,  f  Since  nitrous  oxide  is  reputed  to  raise  blood- 
pressure,  which  may  be  true  of  the  gas  given  undiluted  because  of  the 
attendant  asph^-xia,  the  fact  is  worthy  of  emphasis  that  the  mixture 
with  oxygen  does  not  show  clinically  any  rise  of  blood-pressure. 

Asphyxia. — The  condition  of  asphyxia  (which,  in  this  relation,  may 
be  defined  to  be  lack  of  a  sufficient  ox^'gen  supply  to  the  cells  of  the  tis- 
sues), is,  without  question,  a  factor  in  anesthesia  in  cases  where  an  agent 
is  administered  with  a  limited  supply  of  air.  It  was  formerly  held  by 
high  authority  that  nitrous  oxide  anesthesia  was  due  simply  to  asphyxia, 
but  this  has  been  disproved  by  the  fact,  now  daily  observed,  that  anes- 
thesia is  induced  by  nitrous  oxide  when  mixed  with  sufficient  oxygen  to 
prevent  asphyxia.  It  is  simply  a  question  of  dep^i^^ation  of  oxygen, 
without  which  the  cells  cannot  function;  and  it  is  only  with  the  use  of 

*  Casto,  Am.  Year  Book  of  Anesthesia,  1915;  Henderson,  Ibid,  p.  96. 
t  McKesson,  Am.  Year  Book  of  Anesthesia,  1915,  pp  90-91. 


ACTION  OF   ANESTHETICS   UPON  NERVE  CELLS  189 

nitrous  oxide  alone  and  of  ether  by  the  old,  closed  inhaler  method,  that 
we  encounter  asphyxia  in  any  important  degree.  However,  asphyxia 
is  of  primary  importance  in  its  causative  relation  to  auto-intoxication, 
under  which  topic  it  will  be  further  discussed. 

Action  of  Anesthetics  upon  Nerve  Cells. — While  the  precise  action  that 
determines  the  paralysis  of  function  of  nerve  cells  in  the  state  of  anes- 
thesia has  not  been  demonstrated,  much  light  is  thrown  upon  the  ques- 
tion by  Lillie  in  his  comprehensive  article  on  "The  Physico-chemical 
Theory  of  Anesthesia,"*  which  details  the  researches  of  himself  and 
others.  Lillie  defines  anesthesia,  in  reference  to  all  responsive  tissues, 
as  "the  ijhenomenon  oj  reversible  decrease  of  activity  of  responsiveness." 
He  argues  from  the  proposition  that  the  response  of  cells  to  stimulation 
probably  begins  at  the  surface  of  the  cell,  i.  e.,  that  surface  changes, 
where  the  cell-wall  (or  "plasma  membrane")  must  first  meet  the  stimu- 
lating agent  in  the  surrounding  medium,  are  responsible  for  the  activity 
that  follows  in  the  cell  as  whole.  It  is  evident  that  anesthetics  decrease 
temporarily  the  responsiveness  of  nerve  cells,  and  it  is  reasonable  to 
assume  that  the  action  begins  at  the  sm*face  where  the  anesthetic  first 
reaches  the  cell.  But  whether  the  action  consists  of  physical  change  of 
the  fat-like  (lipoid)  constituents  (Meyer  and  Overton),  whether,  by  this 
or  other  change,  oxidation  is  restrained,  or  whether  the  protein  constitu- 
ents are  affected  either  physically  or  chemically,  remains  to  be  proved. 
Lillie  believes  that  the  action  begins  at  the  surface.  To  quote  from  his 
earlier-expressed  view,  "anesthetic  action  is  due  primarily  to  a  modifi-' 
cation  of  the  plasma-membrane  of  the  cells  or  irritable  elements,  of  such 
a  kind  as  to  render  these  membranes  more  resistant  toward  agencies 
which  under  the  usual  conditions  rapidly  increase  their  permeability; 
cytolysis  and  stimulation,  both  of  which  depend  on  such  increase  of 
permeability,  are  hence  checked  or  prevented  ....  this  effect 
is  produced  by  various  salts,  e.  g.,  of  magnesium,  and  by  ether  and 
other  lipoid-solvent  anesthetics  in  certain,  not  too  high,  concentrations. 
....  It  seems  clear  that  for  irritable  tissues  the  state  of  the  lipoids 
in  the  plasma-membrane  largely  determines  the  readiness  with  which 
changes  of  permeability — and  of  the  dependent  electrical  polarization 
— are  induced  by  external  agencies."  The  essence  of  this  theory  seems 
to  be  that  the  anesthetic  in  some  way  lessens  the  permeability  or  the 
electrical  conductivity  of  the  cell  surface,  so  that  response  to  the  usual 
stimuli  is  prevented. 

*  Am.  Year  Book  of  Anesthesia,  1915,  pp.  1-30. 


190  ANESTHETICS 

We  may  state,  therefore,  that  present  theories  are  \ariously  char- 
acterized by  (a)  behef  in  physical  change  of  the  Hpoids,  (h)  in  decreased 
oxidation,  and  (c)  in  alteration  of  electric  polarization  upon  the  cell 
surface;  also,  that  these  theories  deal  more  with  the  mechanism  of  induc- 
tion than  with  the  essential  state  of  the  narcotized  cell. 

Whatever  theory  is  fa^'o^ed,  it  is  evident  that  the  phenomenon  of 
anesthesia  involves  selective  action,  i.  e.,  certain  nerve  centers  are 
affected  before  others.  The  usual  order  is  for  the  cerebral  areas  to 
be  affected  first,  the  spinal  cord  second,  while  the  medullary  centers  are 
affected  last.  In  fact,  any  agent  whose  action  does  not  exhibit  this 
selective  order  cannot  rank  as  a  safe  anesthetic,  for  the  respiratory 
centers  in  the  medulla  must  remain  active  during  anesthesia  of  brain 
and  spinal  cord.  A  recognition  of  this  order  also  furnishes  an  index  as 
to  danger  or  safety  in  the  course  of  its  inhalation.  Plate  V.  will  aid  us 
in  appreciating  the  stages  tlirough  which  the  action  of  anesthetics  may 
extend,  the  numbers  1  and  2  pertaining  to  essential  and  safe  anesthesia, 
and  3  and  4  to  the  dangers  of  profound  anesthesia. 

Stages  of  Anesthesia. — Descriptions  of  the  stages  of  anesthesia  are 
sometimes  so  elaborate  as  to  be  confusing.  The  simple  division  of 
Cushny  into  three  stages  seems  sufficient  for  ether  and  chloroform  at 
least. 

A.  Imperfect  Conscionsness* — At  the  beginning  the  inhalation  may 
be  accompanied  by  a  sense  of  suffocation,  which  is  greater  with  ether 
than  with  chloroform  and  is  seldom  present  with  nitrous  oxide. 

The  cerebrum  is  very  quickly  affected,  with  the  production  of  ^•arious 
manifestations  of  disturbed  or  uncontrolled  nerve  function,  such  as 
incoherent  talking,  laughing  or  crying,  indefinite  muscular  movements 
and  holding  of  the  breath.  The  pulse  is  not  much  influenced  as  a  rule. 
Respiration  is  quite  normal  except  for  the  influence  of  the  early  choking 
sensation  when  the  anesthetic  vapor  is  too  concentrated. 

The  pupils  are  responsive  to  light  and  are  apt  to  be  dilated.  The 
specJal  senses  may  be  disturbed.    Coughing  is  occasionally  present. 

B.  Excitement. — With  consciousness  completely  abolished,  the  control 
of  the  lower  part  of  the  cerebrospinal  system  by  the  cerebrum  is  removed, 
and  we  see  accordingly  various  manifestations  of  uncontrolled  reflex 
activity.    The  centers  here  concerned  are  mostly  situated  in  the  spinal 

*  This  stage  is  described  by  some  authorities  as  the  stimulant  stage,  but  the  stimu- 
lant effects  noted  are  mainly  reflex,  while  the  real  concUtion  is  one  of  depressed 
consciousness.  There  is  frequently  noticed  quite  early  a  very  brief  period  of  com- 
plete relaxation,  during  wliich  a  slight  operation  might  be  performed. 


IMPORTANT   THINGS   TO   WATCH  191 

cord,  which  is  the  second  division  of  the  nervous  system  to  be  influenced 
by  anesthetics.  (See  Plate  V.)  Being  not  yet  depressed  to  any  marked 
degree,  the  impulses  that  it  originates  without  cerebral  control  may 
produce  the  most  violent  muscular  action,  which  is  likely  to  be  most 
marked  shortly  before  complete  relaxation  occurs. 

This  stage  of  excitement  is  more  decided  with  ether  than  with  chloro- 
form, whose  general  depressant  effect  is  early  evident,  or  with  nitrous 
oxide,  whose  action  in  every  stage  is  transient.  The  pulse  is  not  much 
altered.  Respiration  may  be  interrupted  by  rigidity  of  the  respiratory 
muscles.  The  pupils  are  apt  to  be  dilated  during  excitement.  They  are 
responsive  to  light  as  long  as  reflex  irritability  persists. 

Increased  secretion  of  tears,  and  of  mucus  in  the  upper  respiratory 
and  oral  regions,  occur.  Vomiting  occurs  as  a  very  unpleasant  com- 
plication if  the  stomach  contains  any  food,  especially  when  ether  is 
employed. 

During  this  stage  consciousness  to  pain  is  abolished,  but,  as  a  rule, 
surgical  procedure  is  impracticable  until  complete  relaxation  occiu-s, 
with  cessation  of  reflex  excitement,  which  marks  the  beginning  of 
complete  anesthesia.  Relaxation  is  generally  accompanied  by  snoring 
inspirations  due  to  vibration  of  the  relaxed  soft  palate. 

C.  Anesthesia. — AYith  the  occurrence  of  complete  anesthesia  the  whole 
muscular  system  is  relaxed,  sleep  is  profound  and  reflex  activity  is 
absent;  in  fact,  there  is  temporary  total  paralysis  of  nervous  and 
muscular  systems,  except  those  parts  concerned  with  respiration  and 
circulation.  The  pulse  is  not  much  altered  in  rate,  but  blood-pressure 
may  be  lessened  (vide  ante).  Respiration  is  full  and  regular,  as  during 
profound  sleep.  The  pupils  are  usually  contracted  and  do  not  respond 
to  light.  The  cornea  is  insensible  to  touch.  The  general  appearance 
does  not  differ  much  from  that  of  a  person  in  a  deep  sleep.  However, 
with  ether  the  face  is  apt  to  be  more  flushed  than  with  chloroform.  ^Yith 
nitrous  oxide  given  alone  some  degree  of  cyanosis  occurs. 

The  Important  Things  to  Watch  during  the  administration  of  an  anes- 
thetic may  be  grouped  as  below: 

First,  as  indicating  the  progress  and  degree  of  anesthesia: 
(a)  The  activity  of  the  reflexes. 
(6)  The  degree  of  muscular  resistance. 
(c)  The  condition  of  the  pupil  of  the  eye. 

As  shown  in  Plate  \,  reflex  activity  persists  after  consciousness  is 
lost,  but  disappears  with  surgical  anesthesia.  Therefore,  as  long  as  any 
response  to  irritation  of  a  highly  sensitive  area  occurs,  and  as  long  as 


192  ANESTHETICS 

any  muscular  rigidity  exists,  we  cannot  say  that  the  proper  degree  of 
anesthesia  has  been  reached.  The  usual  way  of  testing  reflex  irritability 
is  by  toching  the  cornea  or  conjunctiva  of  the  eye  with  the  finger,  which 
should  be  clean.  The  reflexes  of  the  eye  being  among  the  last  to  dis- 
appear, any  response  by  a  closing  movement  of  the  eyelids  shows  that 
irritability  of  reflex  centers  still  persists,  while  absence  of  any  response 
usually  indicates  that  anesthesia  is  complete. 

Muscular  resistance  is  usually  tested  by  raising  the  patient's  arm  to 
full  length  perpendicularly  and  allowing  it  to  fall.  iVny  slowness  or  inter- 
ruption in  its  fall  shows  muscular  response  and  indicates  that  anesthesia 
is  not  complete,  while  a  sudden  drop  of  the  arm,  as  if  paralyzed,  shows 
complete  muscular  relaxation  and  indicates  that  anesthesia  to  a  surgical 
degree  has  been  secured. 

Muscular  resistance  often  persists  after  ordinary  reflex  response  is 
lost.  This  is  of  special  importance  in  dental  operations,  where  it  is  fre- 
quently found  that  the  jaws  are  rigidly  closed  wdien  anesthesia  seems 
complete.  In  such  cases  it  is  necessary  to  push  the  effect  beyond  the 
degree  which  might  suffice  for  an  operation  upon  an  accessible  surface, 
in  order  to  secure  relaxation  of  the  jaws,  unless  a  mouth-gag  or  a  cork 
be  used  to  keep  the  jaws  apart  during  the  wdiole  period  of  inhalation. 

Again,  owing  to  the  necessity  of  suspending  inhalation  of  the  anes- 
thetic during  the  dental  operation,  as  for  extraction,  it  is  advisable  to 
push  the  administration  to  a  profound  degree,  so  that  the  effect  may  last 
during  the  brief  operation.  This  is  permissible  with  the  safer  anes- 
thetics, which  do  not  endanger  the  heart's  action.  It  may  be  stated, 
however,  that  an  operation  may  be  completed  even  after  reflex  activity 
is  again  evident,  provided  that  muscular  resistance  does  not  prevent; 
for  if  consciousness  be  still  abolished  the  patient  cannot  interpret  the 
surgical  irritation  as  pain,  and  will  remember  nothing  of  the  opera- 
tion, even  though  some  struggling  may  have  occurred  through  reflex 
activity.  Such  a  practice,  however,  is  not  permissible  with  chloroform, 
in  fact  is  dangerous,  as  will  be  explained  in  discussion  of  that  agent. 

The  pupils  remain  responsive  to  light  so  long  as  anesthesia  is  not 
complete,  w4th  a  tendency  to  dilatation  during  the  early  stages,  due  to 
the  excitement  that  is  more  or  less  evident.  With  complete  anesthesia 
the  pupils  contract  and  become  fixed,  i.  e.,  they  do  not  respond  to  light, 
and  appear  in  all  respects  as  they  do  during  profound  sleep.  After 
complete  anesthesia  has  been  induced,  dilatation  of  the  pupil  may  mean 
either  slight  return  of  reflex  activity,  which  will  be  accompanied  by  the 
eye  reflex  and  may  call  for  more  anesthetic,  or  it  may  mean  a  paralysis. 


IMPORTANT   THINGS   TO   WATCH  193 

which  indicates  a  most  serious  depression  of  the  nervous  system  that 
may  be  speedily  fatah  The  latter  will  be  unaccompanied  by  any  sign 
of  reflex  activity  or  of  muscular  resistance,  but  relaxation  will  be 
complete. 

Second,  as  indicating  danger,  note  should  be  taken  of: 

(a)  The  respiration. 

(b)  The  pulse  (with  chloroform  especially) , 

(c)  The  pupil. 

It  must  be  insisted  upon  that  the  respiration  be  watched  closely 
throughout,  for  it  has  been  shown  that  death  by  anesthetics  is  due, 
in  the  majority  of  cases,  to  failure  of  respiration  centrally,  by  paralysis 
of  the  respiratory  centers  in  the  medulla.  Early  in  the  administration 
respiration  may  be  interrupted  by  choking  sensations,  and  after  con- 
sciousness is  lost  there  is  often  some  stoppage  due  to  reflex  muscular 
action;  with  ether  this  may  be  so  marked  as  to  cause  a  considerable 
degree  of  cyanosis. 

These  interruptions  are  temporary,  and  as  long  as  the  pupils  are 
responsive  they  need  not  occasion  any  alarm,  for  any  stoppage  of 
respiration  before  anesthesia  is  complete  is  not  dangerous,  except,  that 
mechanical  closure  of  the  glottis  by  falling  back  of  the  tongue  might 
occasion  a  continued  stoppage,  resulting  in  fatal  asphyxia.  This  cause 
will  be  removed  by  drawing  the  tongue  forward  by  forceps  or  a  silk 
ligature  passed  through  it,  or  by  either  of  two  simple  procedures  that 
are  usually  successful — turning  the  head  to  one  side  so  as  to  allow  the 
tongue  to  fall  to  the  side,  and  drawing  forcibly  forward  both  angles  of 
the  lower  jaw. 

Whenever  interruption  of  respiration  has  occurred  reflexly  or  mechan- 
ically, the  first  succeeding  inspiration  is  apt  to  be  deep  and  forcible. 
With  chloroform  especially,  care  must  be  taken  not  to  allow  free  access 
of  the  drug  with  this  deep  inspiration,  for  fear  of  suddenly  poisoning 
the  heart  by  too  much  or  too  concentrated  vapor. 

During  complete  anesthesia  respiration  is  slow  and  regular  as  in 
normal  sleep.  It  is  most  important  to  watch  the  respiration  at  this  time. 
Any  irregularity  or  interruption  is  a  danger  sign,  and  must  require  sus- 
pension of  the  inhalation,  free  access  of  air,  and  respiratory  stimulants. 
If  cessation  has  occurred,  artificial  respiration  must  be  resorted  to  at 
once.  To  begin  with,  these  measures  may  be  instituted  without  regard 
to  the  pulse,  for,  with  respiration  paralyzed,  the  pulse  may  still  be  feebly 
perceptible,  or  the  heart  may  be  beating  so  feebly  as  to  cause  no  pulse 
in  the  peripheral  vessels.  In  either  case  the  rapid  elimination  of  the  drug 
13 


194  ANESTHETICS 

by  exhalation,  and  the  free  supply  of  oxygen  by  inhalation,  are  most 
urgently  required. 

TJie  pulse  tells  us  of  the  rapidity  and  rhythm  of  the  heart's  action  and 
of  the  condition  of  arterial  pressure.  It  may  be  felt  at  the  wrist,  but  is 
very  conveniently  felt  by  the  anesthetist  at  the  temporal  artery.  Any 
excessive  rapidity  (say  above  120  per  minute)  and,  even  more  important, 
any  irregularity  or  inarked  weakness  of  the  pulse  beats,  should  enlist 
attention.  Rapidity  and  irregularity  are  necessarily  due  to  conditions 
in  the  heart  or  its  regulating  mechanism,  while  weakness  of  the  pulse 
may  be  due  in  part  to  low  blood-pressure  from  relaxation  of  the  arterioles. 
Stimulation  of  the  circulation  during  anesthesia  requires  those  agents 
that  will  maintain  arterial  pressure,  and  forbids  the  use  of  vasodilators 
which  lower  arterial  pressure.  The  recumbent  posture  with  head  low 
must  be  maintained  when  the  pulse  is  weak  or  irregular.  With  ether, 
the  pulse  seldom  shows  any  danger  symptoms,  but  remains  quite  normal 
throughout,  except  that  in  prolonged  anesthesia  arterial  pressure  is 
lessened.  With  chloroform,  the  direct  depressant  action  of  the  drug  upon 
the  heart  and  vasomotor  system  is  added  to  the  general  depression  of 
anesthesia,  and  there  is  accordingly  a  weaker  pulse,  lowered  arterial  pres- 
sure, and  less  ability  to  regain  the  normal  in  case  danger  symptoms  occur. 

A  sudden  failure  of  the  heart,  even  early,  is  sometimes  observed  with 
the  administration  of  chloroform.  This  may  be  due  either  to  cardiac 
disease  which  permits  the  organ  to  be  easily  overcome,  or  to  too  rapid 
or  too  concentrated  inhalation  of  the  vapor.  The  necessity  impresses 
itself  of  watching  the  pulse  carefully  throughout  the  administration  of 
chloroform.  According  to  Levy  there  is  less  danger  from  overdose  of 
chloroform  than  from  intermittent  administration.  {See  under  Chloro- 
form.) 

The  Pujnls. — The  danger  symptom  that  may  be  presented  by  the 
pupils  occurs  only  during  profound  anesthesia,  and  consists  of  dilata- 
tion. This  may  represent  stimulation  of  the  dilator  center  due  to 
asphyxia,*  but  it  has  also  been  taken  to  mean  a  paralysis  of  the  con- 
tractor fibers.  It  is  possible  that  in  different  cases  both  explanations 
may  find  application.  Paralysis  would,  of  course,  be  regarded  as  the 
more  serious  condition.  During  profound  anesthesia  the  pupil  should  be 
observed  veryjrequently,  and  any  dilatation  not  accompanied  by  response 
of  reflexes  should  require  suspension  of  the  anesthetic  and  immediate 
attention  to  the  patient's  condition. 

*  Sollmann,  Text-book  of  Pharmacology,  1901,  p.  441. 


CONTRA-INDICATIONS   TO  ANESTHETICS  195 

Recovery  from  Anesthesia  varies  in  time  from  a  very  few  minutes  after 
nitrous  oxide  and  chloride  of  ethyl,  to  several  hours  after  ether.  The 
patient  may  pass  through  a  stage  of  excitement  similar  to  that  preceding 
anesthesia,  but  less  pronounced  as  a  rule.  Vomiting  almost  invariably 
occurs  when  much  ether  or  chloroform  has  been  used.  After  these  drugs 
there  is  also  a  tendency  to  sleep,  and  normal  consciousness  may  not  be 
restored  for  several  hours. 

Contra-indications  to  Anesthetics. — In  general,  we  may  say  that  anemia, 
disease  of  brain,  lungs,  heart,  bloodvessels  or  kidneys  contra-indicate 
general  anesthetics.  But  a  general  rule  admits  of  many  exceptions,  and, 
therefore,  with  respect  to  this  matter  each  case  must  be  judged  by  itself. 
As  to  contra-indications  to  individual  agents  more  definite  statements 
can  be  made. 

For  Nitrovs  Oxide. — It  is  usually  held  that  serious  heart  or  lung 
affections,  that  will  easily  lead  to  embarrassment  of  respiration  or  circu- 
lation when  the  asphyxia  accompanying  the  use  of  nitrous  oxide  is  added, 
should  prohibit  the  use  of  this  gas;  also  that  disease  of  the  arterial  walls 
to  the  point  of  weakening  them,  presents  the  danger  of  rupture  under 
nitrous  oxide.  This  statement  is  based  upon  the  fact  that  asphyxia 
leads  to  contraction  of  arterioles,  with  increased  blood-pressure  in  the 
smaller  arteries.  Apoplexy,  from  arterial  rupture  within  the  brain, 
would  be  the  most  serious  result  to  be  feared.  These  contra-indications 
may  be  largely  removed  by  the  combined  administration  of  oxygen 
with  the  nitrous  oxide. 

For  Chloroform. — In  addition  to  the  general  statement  above,  we 
should  note  that  disease  of  the  heart  muscle  (myocarditis,  myocardial 
degeneration  or  fatty  degeneration)  prohibits  the  use  of  chloroform.  As 
this  drug  is  capable  of  causing  fatty  degeneration  of  various  organs,  the 
structure  of  all  circulatory  and  eliminative  organs  should  be  normal  in 
order  to  admit  of  its  use.  Valvular  disease  of  the  heart,  if  well  compen- 
sated, is  less  a  contra-indication  than  is  degeneration  of  the  heart  muscle 
as  indicated  by  weakness,  irregularity  or  dilatation.  It  has  been  shown 
by  experiments  upon  cats,  that  the  administration  of  adrenalin  under 
light  chloroform  anesthesia  is  usually  fatal.  In  the  human  subject 
also  cases  of  death  have  occurred  under  similar  conditions.*  Supra- 
renal preparations,  therefore,  are  positively  contra-indicated  in  chloro- 
form anesthesia. 

For  Ether. — The  general  contra-indications  given  above  apply  typically 
to  ether,  with  discrimination  as  to  any  special  case.    It  is  to  be  noted 

*  Am.  Year  Book  of  Anesthesia,  1915,  p.  118. 


196  ANESTHETICS 

that  ether  has  very  little  depressant  action  upon  the  heart;  on  the 
contrary,  it  diminishes  the  hemoglobin  appreciably  and  would,  accord- 
ingly, be  contra-indicated  in  any  case  of  anemia  showing  GO  per  cent,  or 
less  of  hemoglobin.  On  account  of  the  comparatively  large  amount  of 
ether  required,  it  is  believed  by  some  to  be  particularly  damaging  to 
the  eliminative  organs,  especially  the  lungs  and  kidneys,  but  it  is  prob- 
able that  the  effects  here  are  less  permanent  and  less  serious  than  those 
produced  by  chloroform.* 

While  we  should  always  give  due  place  in  our  judgment  to  the  general 
contra-indications  previously  stated,  when  any  anesthetic  is  in  question, 
yet,  when  we  have  mentioned  the  unpleasantness  of  ether  inhalation,  the 
excitement  that  it  frequently  causes,  and  the  prolonged  and  uncomfort- 
able period  of  recovery,  we  have  made  our  chief  complaints  against 
ether.  It  stands  first  as  a  safe  general  anesthetic  for  profound  and  pro- 
longed effect. 

Auto-intoxication  and  Asph3rxia. — One  danger  of  anesthesia  that  has 
not  been  sufficiently  recognized  is  that  of  auto-intoxication.  Asphyxia 
is  an  important  factor  in  causing  this  condition,  as  by  the  deficiency  of 
oxygen  the  normal  elaboration  and  final  oxidation  of  tissue  elements  is 
interfered  with;  consequently  elimination  is  deficient  and  acid  waste 
products  accumulate  in  the  tissues.  Also  after  chloroform  and  ethyl 
chloride  (and  other  related  chemical  substances  which  yield  a  halogen 
acid,  e.  g.,  ethyl  bromide  and  ethyl  iodide),  degeneration  of  liver  cells 
easily  occurs  as  well  as  other  tissue  changes.  There  is  a  growing  belief 
that  auto-intoxications  and  fatty  degeneration  of  organs  in  connection 
with  anesthesia  are  due  mainly  to  acid  products.  Lack  of  oxidation 
may  be  responsible  in  part  for  the  accumulation  of  these,  or  one  of  the 
halogen  acids  may  be  liberated  from  certain  anesthetics. f  Cases  of 
death  occurring  several  days  after  the  use  of  ether  or  chloroform,  the 
immediate  effect  of  the  drug  having  been  recovered  from,  are  often  due 
to  auto-intoxication  rather  than  to  the  particular  anesthetic  employed. 

It  is  true  that  nitrous  oxide  anesthesia,  as  usually  employed  in  den- 
tistry, is  so  brief  that  the  asphyxia  that  necessarily  attends  it  because  of 
the  closed  inhaler  used,  may  be  disregarded  as  of  light  importance;  but 
its  prolonged  use  now  so  common  in  general  surgery,  should  be  accom- 
panied by  inhalations  of  oxygen.  While  we  may  not  insist  upon  the  use 
of  oxygen  as  routine  practice  in  connection  with  anesthesia  of  moder- 

*  See  conclusions  of  Committee  of  the  British  Medical  Association,  Lancet, 
London,  1901,  vol.  i,  p.  280. 

t  Graham,  Am.  Year  Book  of  Anesthesia,  1915,  p.  150. 


AUTO-INTOXICATION  AND  ASPHYXIA  197 

ate  duration,  it  is  certainly  advisable  in  greatly  prolonged  anesthesia 
with  any  agent;  and  objection  must  be  made  to  inhalers  for  ether, 
ethyl  chloride,  or  chloroform  that  do  not  admit  enough  air  for  proper 
oxygenation  of  the  blood.  The  practice  of  rebreathing  the  same  gases 
during  anesthesia  also  is  to  be  discouraged,  unless  for  short  periods  or 
under  expert  supervision.  An  expert  will  often  employ  rebreathing,  but 
with  sufficient  pm-e  oxygen  to  avoid  asphyxia. 

Preparation  of  Patient  for  Anesthesia. — For  ordinary  nitrous  oxide 
anesthesia  it  is  only  necessary  to  be  assured  of  the  non-existence  of 
serious  disease  in  vital  organs  and  in  the  arterial  walls,  and  to  observe 
the  general  precautions  to  be  given  later.  For  prolonged  use  of  the 
same  agent,  similar  preparation  should  be  made  as  for  ether  and  chloro- 
form. 

Before  employing  ether,  chloroform  or  ethyl  chloride,  preparation 
should  be  made  in  order  to  avoid  unpleasant  or  dangerous  complications 
both  during  and  after  the  administration.  Except  in  emergencies  that 
seldom  occur  in  dental  practice,  an  anesthetist  is  not  justified  in  adminis- 
tering one  of  these  agents  without  first  ascertaining  that  no  disease  exists 
in  heart,  lungs,  brain,  bloodvessels  and  kidneys,  nor  any  anemia,  suffi- 
cient to  constitute  a  contra-indication.  It  is  essential  to  examine  the 
patient's  urine  in  every  case.  The  blood-pressure  should  be  taken  as  a 
rule,  and  the  blood  examined  in  any  case  that  presents  the  appearance 
of  anemia  or  chlorosis.  [Less  than  60  per  cent,  of  hemoglobin  should 
contra-indicate  the  use  of  ether,  chloroform  or  ethyl  chloride,  but  nitrous 
oxide  may  be  used  with  care.] 

To  this  routine  is  added  the  positive  injunction  to  the  patient  to  take 
nothing  into  the  stomach  for  at  least  five  hours  before  the  operation  is 
to  occur.  This  will  avoid  vomiting  during  the  administration.  A  free 
cathartic  should  be  employed  within  the  twenty-four  hours  preceding 
the  operation,  particularly  if  constipation  is  present. 

An  imjjortant  precaution,  that  should  invariably  be  taken  if  the  patient 
be  a  woman,  is  to  have  a  third  party  present,  which  in  case  of  dental 
operations  may  preferably  be  a  friend  of  the  patient.  A  case  is  recorded 
where  the  imaginations  of  an  anesthetized  woman  were  such  as  to  form 
the  basis  of  a  charge  of  criminal  assault  against  the  operator;*  therefore 
one  should  guard  against  such  an  unfortunate  possibility  in  any  case  of 
anesthesia  under  his  direction. 

Coming  to  the  time  of  administration,  any  artificial  denture  or  other 

*  Reese.     Medical  Jurisprudence  and  Toxicology,  second  edition,  p.  559. 


198  ANESTHETICS 

appliance  must  be  renl()^■e(l  from  the  mouth.  Wlien  ether  or  chloroform 
is  to  be  used  it  is  well  to  protect  the  eyes  from  the  irritating  vapor  by 
covering  them  with  a  towel.  If  the  greatest  care  is  not  exercised  as  to 
quantity  of  liquid  applied  to  the  inhaler  it  may  drop  upon  the  face  and 
irritate  the  skin.  Some  anesthetists  protect  the  tissues  about  the  mouth 
and  nose  by  covering  the  skin  and  lips  with  a  light  application  of  sweet 
oil  or  vaseline.  The  patient  must  be  informed  of  the  pr()l)able  unpleas- 
antness of  the  vapor,  so  as  not  to  be  surprised  by  the  sense  of  sufl'ocation. 
The  clothing  about  the  neck,  chest  and  waist  should  be  sufficiently 
loose  to  allow  of  free  respiratory  movements,  and  the  patient  should 
finally  l)e  instrueteil  to  breathe  deeply. 

In  case  of  emergency  requiring  an  o])eration  at  night,  ether  must  not 
be  used  in  the  presence  of  a  gas  flame  or  ordinary  fire.  The  vapor  of 
ether  Is  explosive  *  It  is  also  heavier  than  the  air,  and  will  fall  to  the 
floor  and  diffuse  itself  mainly  in  the  lower  part  of  the  room.  It  may, 
therefore,  reach  an  open  fire  at  some  distance  in  explosive  strength, 
without  being  particularly  evident  in  the  upper  part  of  the  room.  The 
only  safe  light  to  use  about  ether  is  the  incandescent  electric  light,  which 
is  fully  enclosed.  Vov  the  same  reason,  it  is  necessary  to  observe  some 
care  in  handling  ether.  It  should  be  kept  and  handled  in  tin  cans  rather 
than  in  bottles,  in  order  to  avoid  accidental  breakage  with  dift'usion  of 
the  explosive  vapor. 

Responsibility  in  the  Use  of  Anesthetics. — With  all  precautions  taken, 
it  still  remains  a  fact  that  occasional  deaths  attend  the  use  of  anesthetics. 
Therefore,  the  question  of  responsibility  in  their  use  becomes  an  impor- 
tant one.    For  slight  operations,  such  as  tooth  extraction,  that  do  not 

*  In  order  to  ascertain  the  degree  of  explosiveness  of  ether  vapor,  a  series  of  ten 
experiments  were  made  by  Government  Chemist  Albert  P.  Sy,  M.S.,  at  the  Sandy 
Hook  ProA-ing  Grounds,  in  March.  1904.  The  tests  were  made  with  mixtures  of 
ether  vapor  and  air  in  strong  glass  flasks,  through  which  the  electric  spark  was 
passed,  explosion  being  e^^denced  by  blo^sing  out  of  the  cork.  In  four  of  the  experi- 
ments, with  mi.xtures  containing  from  0.9.3  per  cent,  to  1.65  per  cent,  by  volume 
of  ether  vapor,  no  explosion  occurred;  while  the  other  six  experiments,  \\-ith  mixtures 
containing  from  1.67  per  cent,  to  2.39  per  cent,  by  volume  of  ether  vapor,  were  each 
attended  by  explosion.  The  minimum  percentage  attended  bj'  explosion  was  1.67  by 
volume,  which  is  the  equivalent  of  0.355  pound  of  ether  vaporized  in  100  cubic  feet 
of  air.    Report  of  War  Department,  Chief  of  Ordnance,  1904,  vol.  x,  p.  163. 

These  experiments  would  seem  to  incUcate  that  in  a  room  of  1000  cubic  feet  space 
(10  X  10  X  10  feet)  anything  less  than  3.5  pounds  of  ether  could  be  vaporized  with- 
out danger  of  explosion.  This  degree  of  concentration  would  never  occur  with  the 
ordinary  use  of  ether  as  an  anesthetic.  The  chief  danger  wou'd  probably  be  in  the 
irregular  diffusion  of  the  vapor  by  reason  of  its  weight,  allowing  concentration  in 
some  part  of  the  room  near  a  flame. 


NITROGEN II   MONOXIDUM—NITROUS  OXIDE  199 

absolutely  require  it,  it  is  well  to  place  the  responsibility  of  deciding  for 
an  anesthetic  upon  the  patient.  With  the  decision  made  and  the  proper 
agent  selected,  it  remains  with  the  operator  to  bring  to  its  administra- 
tion the  requisite  knowledge  and  skill;  and  the  dental  practitioner  must 
determine  how  far  he  will  here  assume  the  responsibility.  It  must  be 
said  that  the  dental  curriculum  of  study  does  not  provide  sufficiently  for 
training  in  physical  diagnosis  and  general  clinical  work  to  fit  the  dental 
specialist  for  the  office  of  anesthetist.  It  is  doubtless  proper  for  him  to 
administer  nitrous  oxide,  but  to  be  prepared  in  all  points  that  are 
involved  in  the  use  of  ether  and  chloroform  requires  a  broad  medical 
training  and  considerable  experience.  The  course  that  is  most  natural 
and  that  places  the  responsibility  where  it  really  belongs,  is  to  refer  the 
whole  matter  of  general  anesthesia  in  any  case  to  the  patient's  own 
physician,  both  for  decision  as  to  the  propriety  of  anesthesia  and  selec- 
tion of  the  agent,  and  also  for  its  administration  and  the  general  care  of 
the  patient.  These  suggestions  are  based  upon  an  appreciation  of  what 
might  be  the  result  of  an  accidental  death,  where  it  was  made  evident 
that  the  anesthetic  was  employed  without  every  reasonable  precaution 
having  been  taken.  Recent  years  have  seen  the  development  of  the 
professional  anesthetist,  to  whom  we  owe  much  of  the  progress  evident 
in  our  knowledge  of  anesthetics  and  in  improved  methods  of  employ- 
ment. It  is  customary  now  for  a  surgeon  to  have  his  own  special 
anesthetist.  In  any  case  in  which  there  is  question  as  to  the  ad^^sa- 
bility  of  giving  a  general  anesthetic,  it  is  well  to  have  the  services  of  the 
expert  in  anesthesia  who  should,  as  a  matter  of  course,  have  had  a 
medical  training. 

Nitrogenii  Monoxidum.  Nitrous  Oxide. — A  gas  having  the  formula  X2O, 
capable  of  being  liquefied  under  pressiu^e.  It  is  colorless,  having  a  slight 
odor  and  a  sweetish  taste.  It  is  soluble  in  water  and  in  alcohol.  It  is 
not  combustible,  but  will  support  combustion. 

This  gas  was  formerly  prepared  by  the  practitioner  for  his  own  use, 
by  heating  ammonium  nitrate  in  a  retort  to  the  point  of  decomposition. 
It  was  collected  and  stored  for  use  in  an  ordinary  gas  tank  over  water. 
Care  had  to  be  exercised  to  avoid  a  degree  of  heat  that  would  develop 
the  higher,  poisonous  oxides  of  nitrogen.  This  method  of  home  manu- 
facture is  now  well-nigh  obsolete,  as  the  gas  can  be  obtained  in  liquid 
form  in  cylinders  of  convenient  size,  and  with  greater  assurance  of 
purity. 

Nitrous  oxide  is  non-irritating  when  inhaled,  and  it  has  been  abun- 
dantly proved  to  be  the  safest  general  anesthetic  known.     Its  effects 


200  ANESTHETICS 

upon  vital  structures  are  so  slight  and  unimportant,  and  the  duration  of 
its  main  effect  so  brief,  that  in  properly  selected  cases  it  should  be  abso- 
lutely safe.  ^Yith  the  very  few  cases  of  reported  death  from  inhalation 
of  this  gas,  it  may  be  questioned  whether  the  results  could  be  attributed 
entirely  to  it.  It  has  been  largely  used  to  induce  transient  anesthesia  for 
slight  operations,  its  most  extensive  use  having  been  for  tooth  extraction. 
At  present  it  is  also  used  in  general  surgery,  and  its  use  has  been  extended 
in  two  special  ways,  first,  by  its  emplo.Miient  to  secure  anesthesia  quickly, 
to  be  followed  by  ether,  thus  shortening  the  period  and  removing  the 
unpleasantnessof  the  early  part  of  ether  administration;  and  seco?id,  by 
its  combined  inhalation  with  oxygen,  whereby  the  element  of  asphyxia 
is  removed,  permitting  the  anesthesia  to  be  continued  indefinitely.  By 
this  latter  method  nitrous  oxide  has  been  adopted  by  many  surgeons  as 
the  anesthetic  of  choice  in  general  surgery;  and  even  for  major  oper- 
ations it  is  largely  used,  always  with  oxygen,  and  supplemented  by  a 
small  amount  of  ether  in  suitable  cases. 

Nitrons  Oxide  Analgesia. — A  comparatively  new  use  to  which  nitrous 
oxide  is  adapted  is  that  of  inducing  analgesia,  without  loss  of  conscious- 
ness, for  any  desired  time  during  the  preparation  of  cavities  in  sensitive 
teeth.  A  nitrous-oxide-oxygen  mixture  is  used,  such  as  experience  shows 
will  maintain  a  state  of  analgesia  without  any  asphyxia  or  loss  of  con- 
sciousness. The  nasal  inhaler  must  be  employed.  As  a  matter  of  course, 
experience  will  be  needed  to  employ  this  method  expertly,  but  it  con- 
tributes to  the  facility  of  handling  a  class  of  hypersensitive  cases  greatly 
to  the  patient's  comfort. 

ComjjJete  Anesthesia  may  usually  be  induced  by  pure  nitrous  oxide 
in  from  two  to  five  minutes,  and  recovery  occurs  in  an  equally  short  time. 
With  the  full  effect  obtained  quickly,  it  is  not  so  easy  to  define  stages  of 
action,  but  we  may  note  about  the  same  order  of  paralysis  as  with  ether. 
The  disturbance  of  consciousness  is  quite  characteristic,  in  that  the 
emotions  are  prominently  affected,  laughing  being  so  often  induced  as 
to  lead  to  the  popular  designation  of  the  substance  as  "laughing  gas." 
Reflex  activity  is  likewise  often  evident,  the  patient  sometimes  even 
needing  restraint.  "When  the  gas  is  given  mixed  with  air,  the  excite- 
ment is  apt  to  be  greater  and  the  anesthetic  effect  more  slowly  produced. 
The  most  striking  feature  of  nitrous  oxide  anesthesia  produced  rapidly, 
is  cyanosis  due  to  the  exclusion  of  oxygen — really  asphyxia.  It  has  been 
held  by  some  that  anesthesia  by  this  agent  is  simply  asphyxia;  but, 
although  asphyxia  will  induce  unconsciousness,  it  is  easily  demonstrable 
that  nitrous  oxide  has  a  specific  anesthetic  action,  for,  with  a  patient 


NITROGEN  1 1  MONOX I DUM— NITROUS  OXIDE  201 

fully  under  its  influence,  the  addition  of  oxygen  will  remove  the  asphyxia 
without  terminating  the  anesthesia,  which  will  contmue  as  long  as  nitrous 
oxide  is  administered. 

Administration. — The  routine  way  of  employing  nitrous  oxide  is 
by  a  closed  inhaler,  which  may  cover  mouth  and  nose  or  nose  only, 


Fig.  7. — Luke's  nitrous  oxide  apparatus.     (Brewer.) 

the  latter  for  continued  administration  in  operations  about  the 
mouth.  The  inlialer  is  of  rubber,  or  of  metal  or  celluloid  with  the 
edges  applying  to  the  face  covered  with  a  rubber  air-cushion,  so  as  to 
apply  closely.  Celluloid  has  the  advantage  of  transparency.  The  part 
where  the  gas  enters  and  the  air  of  expiration  escapes  is  usually  of  metal, 
while  the  tubes  are  of  flexible  material.    For  prolonged  operations  about 


202  ANESTHETICS 

the  mouth  the  pharyngeal  method  is  often  employed.  Instead  of  the 
usual  inhaler  this  method  employs  two  small  tubes  which  pass  through 
the  nostrils  into  the  pharynx,  thus  leaving  the  face  entirely  uncovered. 

As  to  the  apparatus,  the  old  gas  tank  of  the  dental  office,  for  nitrous 
oxide  alone,  has  been  supplanted  by  several  makes  of  portable  apparatus 
arranged  for  combined  use  of  N2O  and  O,  with  means  of  easy  regulation 
of  the  mixture.  Some  of  these  are  sufficiently  light  and  compact  to  be 
carried  about  when  necessary.  Such  apparatus  accommodates  separate 
cylinders  of  N2O  and  of  O,  with  rubber  gas  bag  to  receive  the  mixture, 
while  the  regulating  mechanism  permits  the  use  of  pure  X2O  or  any 
desired  mixture,  or  pure  O  if  emergency  requires. 

Advantages  of  Nitrons  Oxide. — A  summary  of  the  points  that  give  to 
N2O  the  place  of  preference  is  as  follows: 

1.  Being  non-irritating,  its  inhalation  gives  no  discomfort. 

2.  Anesthesia  is  induced  quickly  and  recovery  follows  quickly,  with- 
out unpleasant  after-effects. 

3.  It  has  very  little  effect  either  upon  the  blood  elements  (hemo- 
globin or  blood  cells)  or  upon  blood-pressure. 

4.  It  does  not  depress  the  heart  to  any  appreciable  degree. 

.  5.  Its  contra-indications  and  dangers  are  practically  removed  by  the 
addition  of  oxygen. 

6.  Used  with  sufficient  oxygen,  its  employment  may  be  greatly  pro- 
longed, with  a  minimum  of  auto-intoxication. 

7.  It  permits  the  addition  of  ether  vapor  when  a  more  profound 
effect  is  needed. 

5.  It  is  a  practical  general  analgesic  when  the  abolition  of  painful 
sensation  is  the  only  essential. 

Mthei. — Ether. — Ethylic  Ether. — Composed  of  96.5  per  cent,  of  ethyl 
oxide  [(C2H5)20]  and  3.5  per  cent,  of  alcohol;  prepared  by  the  action  of 
sulphuric  acid  upon  alcohol,  hence  sometimes  called  "sulphuric"  ether. 
It  is  a  light,  colorless,  volatile  liquid,  with  a  penetrating  odor  and  dis- 
agreeable, burning  taste,,  having  a  specific  gravity  of  0.713  to  0.716  at 
25°  C.  (77°  F.).  Its  vapor  is  about  2^  times  heavier  than  air,  and  may 
be  explosive  when  mixed  with  air  and  brought  into  contact  with  a  flame. 
It  is  soluble  in  about  12  times  its  volume  of  water,  and  is  raiscible  with 
alcohol,  chloroform  and  oils.    Average  internal  dose,  TTl  15  (1  mil). 

Ether  boils  at  about  35°  C.  (95°  F.).  One  test  of  its  strength  is  that, 
in  a  test-tube  half-filled  and  containing  fragments  of  broken  glass, 
it  should  boil  by  the  heat  of  the  hand,  when  the  tu})e  is  closely  grasped 
and  held  for  some  time.     The  vapor  being  explosive,  ether  should  be 


PLATE    VI. 


Varjiis  Center 

Vaso  Motor 

Center 
Cervical 
Symjjathetic 


Solar  Plexus 


^THER. 


The  blue  color  indicates  depression 
caused  by  ether. 


Stimulant.  Anodyne. 

Anesthetic. 
The  action  of  these  two  substances  is  v< 
wliich  th 

Ph; 

Ether,    in    the   concentrated    form 
which    it  is   administered,  is  more  in 
tating  than  chloroform,  tiierefore  tlie  pi 
mary  reflex    stimulation    and   the    lat' 
excitement  are  mucii  more  pronouncer 

It  may  cause  danger  by  paralysis  ( 
respiration,  but  the  heart  is  depress* 
so  slightly  that  recovery  may  usually  1 
secured. 


Locally  a])plied,  the  drug  is  an  irritar 


Nervous  System. 

Brain.      Depresses  cerebrum,  abf)lis 

iiig  all  of  its  functions. 
Medulla.  Of  the  whole  central  nt 
vous  system  the  medulla  is  affecti 
last.  In  dangerous  narcosis  the  i 
spiratory  and  vasomotor  centers  a 
])aralyzed. 
Spinal  cord.  Abolishes  all  fur 
tions,  the  sensory  side  being  par; 
yzed  before  the  motor. 

Circulation. 

Not  much  altered  from  the  normal  u 
til  anesthesia  is  profound,  when  ; 
terial  pressure  is  diminished. 
Heart.  Early  may  show  reflex  stim 
lation.  Later  not  much  affect^ 
unless  administration  is  prolongs 
when  some  depression  may  occur. 
Capillary  area.  Home  dilatation 
cutaneous  arterioles  usually  occu 
with  flushing  of  the  face. 

Eye.  Pearly  the  pupils  are  dilated.  Duri' 
complete  anesthesia  they  are  cr 
tracted.  With  dangerous  paraly; 
they  dilate. 

Mesjiiratioit.  May  be  irregular  or  i 
terruj)ted  during  partial  ane.sthes 
During  full  anesthesia  it  is  regul 
and  normal,  as  during  sleep, 
dangerous  narcosis  it  foils,  throu; 
paialysis  of  the  respiratory  center 

Temprrature  is  reduced  during  anesthes 

lletabolism.  Influence  is  usually  slig 
and  transient.  The  drug  is  eliminat 
chiefly  by  the  lungs. 


PLATE    VII. 


CHLOROFORML^I. 


ssified  as  : 


Irritant. 
Anesthetic. 


Anodyne. 
Antispasmodic. 

imilar,  the  main  differences  being  in  the  degree  in 
fleet  various  organs. 

[ogic  action : 

Chloroform  is  pleasanter  to  inhale,  but  much 
more  depressant  to  nerve  center's  and  heart. 

According  to  Cushny,  it  is  3  to  3H  times  _as  de- 
pressant to  the  central  ner\'ous  sj-stem,  and  25  to  30 
times  as  depressant  to  the  heart,  as  is  ether. 

It  usually  causes  death  by  paralysis  of  respi- 
ration, the  heart  continiiing  to  beat,  though  so 
greatly  depressed  as  to  prevent  recovery  in 
many  cases.  However,  it  is  believed  by  many 
that  the  heart  may  in  some  cases  be  paralyzed 
first.  This  is  probably  true  in  cases  of  degen- 
eration of  the  heart. 

Locally  applied,  the  drug  is  an  in-itant,  es- 
pecially when  the  vapor  is  confined,  as  in  the 
production  of  a  "  thimble  blister." 

Nervous  System. 

Brain.    Depresses  the  cerebrum,  abolishing 

all  of  its  functions. 
Medulla.     Of  the  whole  central  nervous 

system  the  medulla  is  affected  last.     In 

dangerous    narcosis    the    respiratoiy  and 

pai-alyzed. 

Spinal  cord.  Abolishes  all  functions,  the  sensory  side  being  paral- 
yzed before  the  motor. 

Circulation. 

Much  more  depressed  by  chloroform  than  by  ether.  Arterial  press- 
ure decidedly  diminished,  probably  by  both  cardiac  and  vasomotor 
depression. 

Heart.  Depresses  the  heai-t  muscle  or  its  ganglia.  By  prolonged 
action  may  cause  fatty  degeneration. 


Capillary  area.     ^Arterioles  relaxed  by  vasomotor  depression. 


Eye.     Early  the  pupiLs  are  dilated.      During  complete  anesthesia  they 
are  contracted.     With  dangerous  paralysis  they  dilate. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Respiration.  During  partial  anesthesia  it  is  dLstiirbed  in  a  reflex  way 
less  than  with  ether.  During  full  anesthesia  it  is  regular  and  nor- 
mal as  during  sleep.  In  dangerous  narcosis  it  fails  through  pai-alysis 
of  the  respiratory  center. 


Temperature  is  reduced  during  anesthesia. 

Melaholism.  Destruction  of  proteids  is  increased  with  less  pei-fect  oxida- 
tion. Fatty  degeneration  of  heait,  liver  and  kidneys  may  occur. 
The  drug  is  eKminated  chiefly  by  the  lungs,  but  it  has  been  found  in 
the  urine. 


The  blue  color  indicates 
depression  caused,  by 
chloroform. 


^THER  203 

kept  in  tin  cans  so  as  to  avoid  danger  of  breakage  with  rapid  diffusion 
of  the  vapor.* 

Plate  VI  represents  the  action  of  ether  upon  the  central  nervous 
system,  the  respiration  and  the  circulation.  (For  preparations  see 
Index  of  Drugs.) 

General  Uses. — ^When  applied  to  the  skin  the  rapid  evaporation  of 
ether  causes  a  decided  cooling  of  the  surface;  applied  to  the  mucous 
membrane  it  is  irritating.  The  stimulant  use  of  ether  preparations 
depends  largely  upon  this  irritant  quality.  The  spirit  and  compound 
spirit  are  employed  in  moderate  doses  as  stimulants,  the  effect  being 
reflex  from  local  irritation  of  the  mucous  membrane.  In  large  doses 
these  preparations  are  anodyne  after  absorption. 

Ether  is  also  a  valuable  solvent  for  resins,  oils,  iodoform  and  many 
other  substances  not  readily  soluble  in  water. 

As  an  Anesthetic. — Since  its  introduction,  three-fourths  of  a  century 
ago,  ether  has  stood  as  our  typical  anesthetic,  combining  efEciency  with 
a  high  degree  of  safety,  and  applicable  in  nearly  all  conditions  requir- 
ing a  general  anesthetic.  With  a  recognition  of  the  greater  dangers 
of  chloroform,  ether  came  to  be  accepted  as  the  routine  agent  in  general 
surgery.  But  in  more  recent  years,  the  development  of  nitrous-oxide- 
oxygen  anesthesia  has  given  advantages  that  have  led  to  its  use  instead  of 
ether  to  a  considerable  ex?tent;  but  even  this  new^er  method  must  rely 
upon  ether  as  an  addition  in  many  cases,  for  profound  anesthesia.  So 
we  may  say  that  ether  holds  its  place  of  primacy,  while  chloroform  has 
fallen  to  a  status  of  very  restricted  use. 

Administration. — It  has  long  been  held  that  the  inspired  air  may  be 
fully  saturated  with  ether  vapor  and  thus  inhaled  for  a  considerable 
period  with  safety;  more  than  this,  the  older  methods  of  etherization 
employed  a  nearly  closed  inhaler  into  which  ether  was  poured  by  the 
one-quarter  to  one-half  ounce  at  intervals.  This  demonstrated  clinically 
that  ether  could  be  given  with  a  limited  supply  of  air  supersaturated 
with  ether  vapor.  This  evidence  of  the  safety  of  ether  led  to  indifference 
as  to  method  of  its  use,  so  that  the  giving  of  ether  was  oftentimes  assigned 
to  a  junior  hospital  interne,  or  to  an  undergraduate  with  no  training  or 
experience  in  anesthesia.  But  that  has  all  been  changed  with  the 
recognition  of  experts  in  anesthesia,  so  that  the  surgeon  now  wants  his 
special  anesthetist  or,  at  least,  a  person  trained  or  experienced.  The 
resultis  that,  with  the  knowledge  of  grave  dangers  incidental  to  pro- 

*  Regarding  the  degree  of  explosiveness  of  ether  vapor,  see  note,  p.  128. 


204 


ANESTHETICS 


longed  narcosis  even  with  ether,  great  care  is  now  taken  as  to  the  method 
of  giving  and  amount  given;  for  it  is  a  cardinal  point  that  the  greater 
the  amount  introduced  in  a  given  time  the  more  profound  the  narcosis, 
and  the  greater  the  interference  with  oxidation  in  the  cell,  and  the 
occurrence  of  acid  intoxication. 

Present-day  methods  of  administering  ether  are  safer,  pleasanter  and 
more  economical.    The  old  cone  inhaler  has  been  largely  supplanted  by 


^^^ 


Fig.  8. — Sander's  mask. 

inhalers  of  various  makes,  all  of  which  secure  a  more  perfect  vapori- 
zation and  more  definite  admixture  with  the  inspired  air.  They  allow 
free  access  of  air,  and  the  ether  is  added  drop  b}'  drop  instead  of  being 
poured  in  in  bulk. 


Fig.  9. — Yankauer's  folding  mask 


The  simplest  form  of  open  inhaler  is  the  Esmarch  (see  Fig.  10),  or 
some  modification  of  it,  so  commonly  used  with  chloroform.  Similar 
to  this,  but  adapted  to  the  drop  method  for  ether  by  being  made  to  fit 
more  closely  to  the  face,  inhalers  such  as  are  shown  above  are  much  used. 
The  gauze  covering  is  easily  added  for  each  administration. 

Other  forms  of  apparatus  present  some  refinements  of  method,  but 
are  less  simple  and  pertain  rather  to  the  specialist  in  anesthesia. 

For  the  use  of  ether  alone  by  the  semi-open-drop  method,  the 
Ferguson  double-chamber  inhaler  is  typical. 


CHLOROFORM  UM  205 

The  double  chamber  supphes  a  space  in  which  the  vapor  is  warmed  to. 
some  degree  by  the  expired  air,  so  that  vaporization  is  faciUtated  and 
the  mixture  is  less  cool  for  inspiration — a  point  to  be  considered  in  pro- 
longed anesthesia.  This  inhaler,  covered  with  about  8  layers  of  gauze, 
allows  an  ether  vapor  percentage  varying  from  6  to  22  per  cent.,  the 
average  of  which  (12  to  15  per  cent.)  would  represent  the  usual  desired 
dilution.  [15  to  30  per  cent,  is  needed  for  induction,  but  the  lower 
percentages  suffice  to  maintain  anesthesia.] 

The  disadvantages  of  ether  commonly  experienced  are  two — first,  the 
unpleasantness  of  the  vapor,  which  will  cause  a  sensation  of  irritation 
and  suffocation  if  not  skilfully  given;  and  second,  nausea  and  headache 
following  the  narcosis.  The  first  can  be  met  by  inducing  slight  anesthesia 
with  nitrous  oxide  or  ethyl  chloride,  changing  to  ether  when  the  sen- 
sations are  benumbed;  or  a  few  di'ops  of  oil  of  orange  preceding  the 
ether  will  sufficiently  mask  its  odor,  if  the  latter  is  then  given  slowly 
at  the  start.  However,  there  is  usually  no  difficulty  if  the  patient  is 
instructed  and  reassured  in  advance  and  the  ether  given  slowly  and  with 
plenty  of  air  at  first.  ^Nlore  difficulty  is  experienced  with  children  before 
the  age  of  cooperation,  so  that  the  preliminary  use  of  ethyl  chloride  or 
nitrous  oxide  may  be  advisable;  though  much  can  be  done  with  a 
sensible  child  through  reassurance  and  the  use  of  the  pleasant  oil  of 
orange  at  first. 

The  second  disadvantage,  nausea  and  headache  following,  cannot  be 
met  so  easily.  These  symptoms  belong  to  intoxication  by  narcotics 
generally,  e.  g.,  morphine  and  alcohol,  and  little  can  be  done  to  mitigate 
them,  except  to  limit  the  amount  of  drug  used. 

Chloroformum. — Chlorofor:m  [CHCI3]. — ^This  stibstance  is  prepared 
by  the  action  of  clilorine  with  an  alkali  upon  alcohol,  and  is  composed 
of  99  to  99.4  per  cent,  by  weight  of  absolute  chloroform  and  1  to  0.6  per 
cent,  of  alcohol.  It  is  a  heavy,  colorless,  volatile  liquid,  with  an  ethereal 
odor  and  sweet,  burning  taste,  having  a  specific  g^a^^ty  of  not  less  than 
1.474  at  25°  C.  (77°  F.).  It  is  soluble  in  210  volmnes  of  cold  water  and 
freely  in  alcohol,  ether,  benzin,  benzol  and  the  fixed  and  volatile  oils. 
Chloroform  should  be  kept  in  dark-colored  bottles  in  a  cool  and  dark 
place.  It  is  not  inflammable,  but  its  heated  A'apor  will  burn  with  a  green 
flame.     Average  internal  dose,  lU  5  (0.30  mil.). 

Preparations : 
C  :  Aquae  chloroformi  (about  0.5  per  cent.).  f54  (15  mils.). 
Spiritus  chloroformi  (6  per  cent.),  TO,  30  (2  mils.). 
Linimentum  chloroformi  (30  per  cent.),  external  use. 


206  ANESTHETICS 

Plate  VII  represents  the  action  of  chloroform  upon  the  central 
nervous  system,  the  respiration  and  the  circulation. 

Aside  from  its  use  as  an  anesthetic,  chloroform  has  grneral  uses  as 
follows : 

As  Anodyne. — Toothache  may  frequently  be  relieved  by  placing  a 
loose  pledget  of  cotton  saturated  with  chloroform  between  the  cheek 
and  the  alveolus  of  the  affected  tooth. 

In  gastric  or  intestinal  colic  the  drug  may  be  given  in  a  dose  of  5- 
15  ITl  (0.30-1  mil.),  dropped  upon  sugar  or  mixed  with  a  fixed  oil. 

In  paroxysms  of  severe  pain  it  may  be  inhaled  cautiously;  in  labor, 
to  lessen  the  severity  of  the  pains  during  the  expulsive  period.  Its  use 
as  an  anodyne  calls  for  discretion  and  the  avoidance  of  every  possibility 
of  overdosage.  It  should  always  be  given  by  a  physician  or  under  his 
direction,  for  it  is  not  safe  for  a  person  to  inhale  this  drug  by  his  own 
administration. 

^4^  Antispasmodic. — To  relieve  infantile  convulsions,  acute  paroxysms 
of  asthma,  uremic  and  puerperal  convulsions.  In  these  conditions  it 
should  never  be  employed  except  with  competent  medical  supervision. 

.4^  Irritant. — It  may  be  used  as  a  counterirritant  in  case  of  neuralgia 
or  other  localized  pain.  The  effect  will  vary  from  mild  irritation  to  the 
production  of  a  blister,  according  to  duration  of  the  application.  If  the 
vapor  be  completely  confined,  as  by  placing  the  drug  upon  cotton  and 
covering  with  a  thimble,  a  small  blister  ("thimble  blister")  is  quickly 
produced. 

As  Solvent. — Chloroform  is  used  as  a  solvent  for  oils,  some  resins, 
caoutchouc,  gutta-percha,  etc. 

As  AN  Anesthetic,  in  spite  of  its  long  history  and  earlier  extensive  use, 
chloroform  today  holds  a  secondary  place,  because  of  its  dangers.  It 
is  much  pleasanter  to  inhale  than  is  ether  and  a  smaller  quantity  is 
required,  which  advantages  make  it  the  agent  of  choice  with  young 
children,  who  seem  to  be  less  susceptible  to  its  poisonous  action.  But 
the  prevailing  opinion  today  is  that  the  use  of  chloroform  with  adults  is 
hardly  justifiable,  except  in  selected  cases.  The  danger  from  this  agent 
depends  upon  its  poisonous  action  upon  the  heart. 

Two  facts  furnish  the  basis  of  this  danger: 

1.  It  has  long  been  held  that  chloroform  is  a  direct  heart  poison, 
depressing  its  action  greatly  and  being  capable  of  causing  fatty  degener- 
ation of  its  structure.  These  effects  are  probably  in  direct  proportion 
to  the  amoinit  or  concentration  of  the  drug. 

2.  Recent  studies  have  shown  that  under  certain  conditions,  chloro- 


CHLOROFORMUM  207 

form  even  in  small  amount  affects  the  heart  peculiarly,'^  rendering  it 
irritable  to  accelerator  impressions  in  a  way  that  may  cause  irregularity, 
fibrillation  and  sudden  death.  This  effect  is  not  likely  to  occur  during 
complete  anesthesia,  when  exciting  impulses  are  blocked. 

Here  we  have  a  new  explanation  of  the  cases  of  sudden  death  under 
chloroform,  that  occur  when  least  expected  and  apparently  unprovoked, 
i.  e.,  before  anesthesia  is  complete  or  during  recovery  from  the  anesthesia. 
Intermittent  administration  has  also  proved  dangerous.  Le^yf  con- 
cludes that  the  "subject  of  light  chloroform  anesthesia  requires  very 
serious  attention"  and  as  a  precaution  "the  first  principles  are  to  keep 
the  patient /i/%  anesthetized  and  to  make  the  adminidration  continuous.'' 
He  argues  against  the  idea  of  overdosage  in  these  cases  and  advocates 
the  use  of  higher  percentages,  temporarily,  when  necessary  (3.5  to  4 
per  cent,  of  chloroform  vapor).  There  should  be  no  disturbance  of  the 
patient  during  induction  of,  or  during  recovery  from,  chloroform  anes- 
thesia and  the  operation  should  not  begin  until  anesthesia  is  complete. 
To  make  an  incision  with  reflexes  acti^-e  is  considered  hazardous. 

Administration — The  conclusion  is  clear  that  the  use  of  chloroform 
should  not  be  resorted  to  lightly  and  that,  when  employed,  adminis- 
tration should  be  by  an  expert.  Because  of  its  depressant  effect  upon 
the  heart,  it  should  be  given  only  with  patient  in  the  recumbent  posture. 
This  being  usually  impossible  in  dental  operations  furnishes  additional 
reason  for  its  non-employment. 

Chloroform  should  be  given  largely  diluted  with  air,  from  an  inhaler 
that  cannot  fit  closely  enough  to  exclude  air.  A  convenient  and  simple 
one  consists  of  a  wire  form  four  inches  in  diameter  with  a  concavity 
to  prevent  contact  with  the  nose.  This  is  covered  with  a  few  layers  of 
gauze,  upon  which  the  chloroform  is  dropped  in  small  quantities  (ten  to 
twelve  drops)  frequently,  or  drop  by  drop  more  continuously  (see  Fig.  7). 

*  It  has  been  found  that  under  chloroform  anesthesia  the  heart  exhibits  an  irrita- 
hility  which  may  respond  to  certain  exciting  causes  in  a  most  pecuhar  way,  e.  g., 
experiments  upon  cats  vmder  chloroform  showed  a  remarkable  development  of  irregu- 
larity of  ventricles  upon  intravenous  injection  of  adrenahn.  The  ventxicles  beat 
rapidly  and  irregiilarly,  exhibiting  the  condition  kno-rni  as  ventricular  fibrillation. 
This  action  is  more  intense  if  the  chloroform  is  diminished  so  as  to  allow  the  corneal 
reflex  to  return,  and  the  result  then  is  usually  fatal,  the  heart  stopping  suddenly 
after  a  period  of  irregularity.  It  is  beUeved  that  accelerator  impulses,  from  the 
central  nervous  system  or  reflexly  through  irritation  of  sensorj'  nerves,  maj"  similarly 
influence  the  heart  under  chloroform.  This  would  account  for  the  cases  of  sudden 
death  occurring  early  in  the  administration  of  chloroform.  Le\w,  "Cardiac  Fibril- 
lation and  Chloroform  Syncope,"  Am.  Year  Book  of  Anesthesia,  1915. 

t  Ibid.,  p.  130. 


208  ANESTHETICS 

The  inspired  air  should  not  usually  contain  more  than  2  per  cent,  of  the 
vapor  of  chloroform.  This  is  in  accordance  with  the  conclusions  of 
the  Special  British  Chloroform  Committee,*  to  the  effect  that  1  to  2 
per  cent,  of  chloroform  in  the  air  is  sufficient  for  anesthesia,  and  that 
these  proportions  are  safe;  0.5  per  cent,  is  inefficient,  while  5  per  cent, 
is  dangerous. 


Fig.  10. — -Esmarch's  inhaler  and  chloroform  bottle.  The  inhaler  consists  of  a  wire 
frame  covered  with  a  piece  of  flannel  or  gauze. 

^thylis  Chloridum, — Ethyl  Chloride  [C2H/I]. — This  drug  is  pre- 
pared by  the  action  of  hydrochloric  acid  gas  upon  absolute  alcohol.  It 
is  a  very  volatile,  colorless  liquid,  having  an  agreeable  odor  and  burning 
taste.  It  is  very  soluble  in  alcohol,  but  only  slightly  in  water.  Its  most 
distinctive  property  is  its  low  boiling-point  (55°  F.).  Vaporizing  rapidly 
at  ordinary  temperature,  it  is  our  most  valuable  and  convenient  refrig- 
erant analgesic.  The  vapor  is  very  inflammable,  therefore  it  should  not 
be  used  near  a  flame.  As  a  general  anesthetic,  ethyl  chloride  has  been 
in  use  for  a  number  of  years,  both  as  preliminary  to  ether,  and  used  alone 
to  induce  transient  anesthesia.  It  ranks  with  nitrous  oxide  as  to  rapid 
and  transient  action,  but  it  is  not  destined  to  become  popular  because  of 
its  dangers.  While  its  relative  safety  among  anesthetics  has  not  yet 
been  definitely  fixed  by  accumulated  statistics,  experience  thus  far  places 
it  below  ether.  In  this  respect  it  must,  for  the  present,  be  classed  with 
chloroform. 

*  Supplement,  British  Medical  Journal,  1903. 


MTHYLIS  CHLORIDUM  209 

An  early  series  of  12,436  cases  of  anesthesia  with  ethyl  chloride  gives 
only  one  death  that  was  proved  to  have  been  due  to  the  drug.  That  case 
had  a  history  of  alcoholic  abuse  and  the  autopsy  revealed  degeneration 
of  heart  and  arteries.* 

McCardief  in  2000  cases  saw  neither  asphyxia  nor  syncope  in  any 
case.  His  estimate  later  gives  one  death  in  3000  cases.  He  has  collected 
records  of  21  deaths,  and  states  that  at  least  30  deaths  are  known  to  have 
occurred  under  ethyl  chloride,  while  several  others  have  occurred  from 
the  proprietary  mixture  called  somnoform. 

Of  the  21  deaths  recorded,  only  3  were  of  children,  and  8  occurred 
in  dental  cases. 

In  these  cases  the  "closed  method"  of  inhalation  is  believed  to  have 
been  commonly  employed.  This  may  have  contributed  an  element  of 
danger;  for  it  cannot  be  too  strongly  emphasized  that,  with  so  powerful 
agents  as  chloroform,  ethyl  chloride  and  ether,  the  limitation  of  air,  by 
use  of  a  closed  inhaler  or  a  bag  which  requires  rebreathing  of  the  vapor- 
laden  air,  adds  a  danger  of  auto-intoxication  which  cannot  be  ignored. 

Experiences  thus  far  lead  the  above  author  to  regard  ethyl  chloride 
as  a  substitute  for  ether  and  chloroform  rather  than  for  nitrous  oxide, 
though  in  children  under  eight  it  is  usually  to  be  preferred  to  nitrous 
oxide.  It  is  to  be  used  with  caution  in  dental  cases,  and  the  recumbent 
posture  is  advised. 

Its  depressant  action  is  more  evident  upon  the  respiration  than  upon 
the  circulation.  When  inhaled  pure,  without  access  of  air,  it  causes  death 
by  paralyzing  respiration.  In  1000  cases  by  Waret  he  noted  6  cases  of 
serious  danger,  all  of  which  were  due  to  interference  with  respiration 
and  all  recovered  under  the  use  of  artificial  respiration.  The  same 
writer,  after  much  experience,  adapts  the  rubber  mouth-piece  of  the 
nitrous  oxide  inhaler  to  ethyl  chloride  (Fig.  8),  as  here  described  in 
his  own  words  :§ 

"The  mask  is  prepared  for  use  by  stretching  two  layers  of  small- 

*  Lotheisen.     Munch.  Med.  Woch.,  November  18,  1900,  p.  601. 

t  British  Med.  Jour.,  March  17,  1906.  Here  also  are  noted  the  foUo\\ang  estimates 
of  the  danger  ratio  of  ethyl  chloride: 

Lotheisen  first  estimated  the  deaths  as  1  :  2.500.  A  later  (April,  1902)  estimate 
by  the  same  xsTiter,  gives  only  1  :  17,000. 

Seitz's  estimate,  at  about  the  same  time,  is  1  :  16,000. 

In  comparison,  the  following  estimates  are  given  for  ether  and  nitrous  oxide: 
Ether  deaths,  1  :  16,000;  nitrous  oxide  deaths,  1  :  1,000,000. 

I  Journal  of  the  American  Medical  Association,  Xo.  8,  1902. 

§  Medical  News,  August  3,  1901,  p.  169. 
14 


210 


ANESTHETICS 


meshed  gauze  over  the  end  of  the  tube  b,  which  is  then  held  taut  by 
being  forced  into  the  neck  c  of  the  funnel-shaped  rubber  mouth-piece  a. 
The  gauze  can  be  renewed  at  will  and  the  whole  apparatus,  because  of 
its  simplicity,  easily  rendered  sterile,  a  feature  devoutly  to  be  wished 
for  in  the  laughing-gas  mask  and  other  kindred  devices.  The  tube  h  is 
the  channel  along  which  the  stream  of  ethyl  chloride  is  directed  against 
the  gauze  c,  intended,  not  merely  to  receive  the  ethyl  chloride,  but  also 
by  impact  to  break  it  into  still  finer  particles.  At  this  point  the  ethyl 
chloride,  evaporating,  expands  and  is  held  by  the  walls  of  the  mouth- 
piece a  and  the  sides  of  the  tube  h,  which,  therefore,  act  as  a  chamber  to 
temporarily  limit  the  vapors. 

"The  entrance  and  exit  of  air  are  through  one  orifice,  so  as  to  mini- 
mize the  loss  of  ethyl  chloride  and  merely  utilize  the  quantity  momen- 


FlG.   11 


tarily  available  for  one  or  two  respiratory  acts.     The  stream  is  to  be. 
delivered  intermittently  from  tubes  provided  with  an  automatic  cut-off." 

With  ethyl  chloride  administered  as  described  above,  with  proper 
admixture  of  air,  anesthesia  is  induced  in  about  the  same  time  as  nitrous 
oxide  requires;  the  effects  correspond  very  closely  to  those  of  the  latter 
as  to  duration  and  recovery,  but  cyanosis  is  absent  throughout. 

For  use  in  dental  practice  it  may  be  said  that,  compared  with  nitrous 
oxide,  ethyl  chloride  is  more  convenient  and  equally  efficient,  though 
less  safe  and  requiring  selection  of  cases  and  cautious  use. 

Somnoform,  a  proprietary  mixture  of  ethyl  chloride  60  parts,  methyl 
chloride  35  parts,  and  ethyl  bromide  5  parts,  presents  no  advantage 
over  pure  ethyl  chloride.    Several  deaths  from  its  use  have  been  reported. 

Comparative  Safety  of  Anesthetics. — The  relative  toxicity  of  these 
agents  must  depend  largely  upon  their  chemical  make-up.  If  we  com- 
pare the  chemical  formuUe  of  the  four  leading  anesthetics,  viz.: 


COMPARATIVE  SAFETY  OF  ANESTHETICS  211 

Nitrous  oxide N2O 

Ether C4H10O 

Ethyl  chloride C2H5CI 

Chloroform CHCI3 

we  note  differences  that  correspond  to  the  increase  in  toxic  power. 
Nitrous  oxide  is  a  very  simple  compound  that  has  slight  effect  upon  pro- 
toplasm. The  hydrocarbon  compounds  have  a  more  decided  effect, 
that  of  ether  being  prolonged  and  profound  without  much  danger  from 
its  action  upon  vital  tissues;  but  with  the  introduction  of  a  halogen 
element  in  combination  with  the  organic  radical,  we  find  the  harmful 
action  to  increase  in  proportion  to  the  number  of  halogen  atoms  in  the 
molecule.  Thus,  ethyl  chloride  contains  a  chlorine  atom  which  makes 
it  more  toxic;  while  chloroform,  with  three  atoms  of  chlorine  is 
decidedly  poisonous  to  tissues,  frequently  causing  a  positive  degen- 
eration.* 

From  these  observations  we  are  led  to  be  skeptical  as  to  the  claims  of 
safety  for  any  new  anesthetic  containing  a  halogen  element. 

Briefly  then,  it  may  be  stated  for  the  agents  now  most  employed,  that 
nitrous  oxide  is  the  safest  anesthetic  in  ordinary  use;  next  in  point  of 
safety  is  ether,  while  chloroform  and  chloride  of  ethyl  remain  the  least 
safe.  The  comparative  safety  of  ether  and  chloroform,  as  given  in  a 
number  of  series  of  statistics,  shows  some  variation,  but  it  may  be  taken 
as  a  fair  statement  that  ether  is  five  times  as  safe  as  chloroform. f 

A  very  interesting  study  of  this  question  is  that  presented  by  the 
Committee  of  the  British  Medical  Association  appointed  to  investigate 
clinically  the  safety  of  the  several  anesthetics. j  They  studied  25,920 
cases  of  general  anesthesia,  all  occurring  in  the  United  Kingdom  in  the 
year  1892.  Their  conclusions  include  not  simply  deaths  from  anesthetics, 
but  all  cases  of  danger  that  could  be  attributed  to  the  agent  used.  They 
found  that  dangerous  sjTQptoms  occurred: 

With  ether,  in  0.065  per  cent,  of  cases.- 

With  nitrous  oxide  and  ether,  in  0.096  per  cent.,  and 

With  chloroform,  in  0.582  per  cent. 

*  The  toxic  effect  may  be  due  to  halogen  acids  Uberated  from  these  compounds. 
See  Am.  Year  Book  of  Anesthesia,  1915,  p.  150. 

t  In  connection  with  tliis,  it  is  interesting  to  note  the  estimate  of  the  comparative 
anesthetic  power  of  ether  and  chloroform.  It  has  been  stated,  as  a  result  of  experi- 
ments, that  "the  concentration  of  ether  in  serum  necessary  for  complete  anesthesia 
is  1  :  400;  of  chloroform,  1  :  4500  to  1  :  6000."  Cited  from  Sollmann,  American 
Medicine,  September  10,  1904,  p.  455. 

t  Lancet,  London,  1901,  vol.  i,  p.  280. 


212  ANESTHETICS 

This  would  make  the  danger  ratio  about  as  follows: 

Chloroform 9 

Nitrous  oxide  and  ether 1.5 

Ether 1 

It  is  conceded  that  nitrous  oxide  alone  is  least  dangerous  of  all. 

Mixtures  of  Anesthetics. — Besides  the  combined  use  of  ether  with 
nitrous  oxide  or  ethyl  chloride,  mixtures  of  anesthetics  cannot  be  very 
strongly  advised.  The  old  A.  C.  E.  mixture  of  alcohol  1  part,  chloroform 
2  parts,  and  ether  3  parts  is  now  seldom  used.  The  differences  in 
specific  gravity  and  volatility  of  the  several  liquids,  make  it  difficult  to 
know  what  proportion  of  each  the  vapor  contains.  The  Schleich  mix- 
tures for  general  anesthesia  are  not  regarded,  in  general,  with  sufficient 
favor  to  constitute  any  recommendation  of  them.  These  must  not  be 
confused  with  the  solutions  for  local  analgesia,  discussed  on  page  173. 
Schleich's  idea  in  introducing  mixtures  of  anesthetics  for  general  anes- 
thesia, was  to  obtain  a  liquid  with  a  desired  boiling-point  (at  about  the 
temperature  of  the  blood),  to  secure  which  he  employed  mixtures  of 
ether,  chloroform  and  petroleum  ether  with  boiling-points  varying 
between  about  100°  and  108°  F.  His  belief  in  the  relation  between  the 
action  of  an  anesthetic  and  its  boiling-point  has  not  been  accepted. 

The  mixture  called  somnoform  (also  advertised  under  the  name  of 
Brugg's  ^Mixture)  cannot  be  advised  for  the  following  reasons: 

1.  Being  proprietary,  its  use  is  unethical. 

2.  It  contains  5  per  cent,  of  ethyl  bromide  [C2H5Br],  which  substance 
is  regarded  as  less  safe  than  ethyl  chloride.* 

3.  ^Yith  new  agents,  such  as  ethyl  chloride,  it  is  better  to  use  the  simple 
substance  until  its  degree  of  safety  has  been  determined,  before  resorting 
to  any  modification  of  it. 

Resuscitation  in  Danger  Cases. — With  nitrous  oxide,  ethyl  chloride, 
ether,  and  usually  with  chloroform,  the  danger  is  paralysis  of  respiration. 
When  the  condition  is  simply  this,  reco\'ery  may  be  expected,  with 
proper  treatment.  But  while  the  condition  is  a  simple  one  with  the 
three  first-named  agents,  with  chloroform  there  is  always  added  a 
serious  depression  of  the  heart,  and  occasionally  paraylsis  of  that  organ. 
When  the  heart  is  paralyzed  by  chloroform  its  irritability  is  lost,  which 

*  Sollmann  (Fliannticolofry,  1906,  ]).  4:iG)  .states  that  ethyl  bromide  "must  not 
be  pushed  to  the  disapi)earanfe  of  reflexes,  since  the  respiration  is  iJaralyzed  about 
the  same  time.  The  zone  of  safety  is,  therefore,  very  narrow."  The  drug  also 
deteriorates  rapidly  after  exposure  to  air. 


RESUSCITATION  IN  DANGER  CASES 


213 


means  death.  But  absence  of  the  pulse  beat  must  not  be  at  once  taken 
to  mean  paralysis,  for,  with  the  depressant  action  of  the  drug  upon  the 
heart,  its  pulsations  may  have  become  so  feeble  as  to  be  imperceptible 
in  the  peripheral  vessels;  and  it  is  not  proper  to  waste  time  at  first  to 
ascertain  the  heart's  condition.    The  important  thing  immediately  is  arti- 


FiG.  12. — Sylvester's  method  of  artificial  respiration:  movement  of  inspiration. 

ficial  respiration,  which  is  itself  here  the  best  cardiac  stimulant,  and  with 
its  faithful  continuance  the  real  condition  of  the  heart  will  soon  appear; 
for  artificial  respiration  not  only  supplies  oxygen  but  facilitates  the  action 
of  the  heart,  by  relieving  engorgement  of  its  chambers,  each  expansion 
of  the  lungs  favoring  the  emptying  of  the  right  ventricle  and  each  con- 
traction furnishing  more  blood  to  the  left  side  of  the  heart  for  distri- 


FiG.  13. — Sylvester's  method  of  artificial  respiration:  movement  of  expiration. 


bution.  The  invariable  treatment,  therefore,  when  respiration  ceases, 
should  be  artificial  respiration  with  free  access  of  air,  preceded,  of  course, 
bv  withdrawal  of  the  anesthetic. 


214  ANESTHETICS 

Artificial  Respiration. — Sylvester's  method  of  artificial  respiration  is 
the  one  most  connnonly  employed.  Figs.  12  and  13  show  the  position  of 
patient  and  attendant.  The  movements  of  inspiration  and  expiration 
should  succeed  each  other  regularly  at  the  rate  of  from  twenty  to  twenty- 
five  respirations  per  minute,  or  once  in  about  three  seconds.* 

In  imitation  of  natural  respiration  the  inspiratory  period  should  be 
slightly  longer  than  the  expiratory.  In  connection  with  this  method, 
massage  of  the  heart  by  an  assistant,  by  pressure  during  expiration 
underneath  the  left  ribs  and  upward  toward  the  heart,  so  as  to  press  the 
latter  between  diaphragm  and  chest  wall,  has  come  to  be  employed  as 
an  important  aid  in  reestablishing  the  heart's  efficiency.  It  is  most 
effectual  in  cases  where  the  irrritability  of  the  heart  muscle  is  not  much 
impaired. 

The  Schdfer  or  Prone-pressure  method  has  gained  favor  in  this  country, 
as  being  at  least  as  efficient  as  the  Sylvester  method  and  more  easily 
performed  by  one  person,  since  it  requires  less  muscular  exertion.  It  is 
carried  on  as  follows:  Have  patient  lying  flat,  with  face  downward  and 
turned  to  side,  tongue  drawn  forward  and  arms  extended  above  head. 
Kneel  aside,  or  preferably  astride,  the  patient's  thighs.  For  the  expira- 
tory movement  place  hands  upon  lower  part  of  chest,  thumbs  nearly 
touching  and  fingers  spread  out  over  lower  ribs;  by  a  forward  move- 
ment throw  your  weight,  through  your  arms,  upon  patient's  chest,  thus 
compressing  both  chest  and  abdomen  and  effectually  expelling  air  from 
lungs.  For  the  inspiratory  movement  spring  backward,  relieving  the 
pressure  completely  to  allow  chest  to  expand,  but  keeping  hands  in 
place.  Time  the  movements  to  15  to  20  complete  respirations  per 
minute,  or  by  your  own  respiration — the  forward  expiratory  movement 
with  your  expiration  and  the  backward  movement  with  your  inspiration. 

The  Howard  method  of  artificial  respiration  also  is  convenient  and 
useful.  It  is  described  as  follows :t  "The  patient  is  turned  upon  his 
back,  and  a  bolster  of  clothing  or  of  other  material  is  placed  under  him 
so  as  to  throw  his  epigastrium  forward.  His  wrists  are  crossed  behind 
his  head  and  held  in  that  position.  His  tongue  is  drawn  forward  and 
held  with  a  dry  handkerchief  in  the  extreme  corner  of  his  mouth.  The 
operator  now  kneels  astride  the  patient's  hips,  '  resting  the  ball  of  each 
thumb   upon   the   corresponding  costoxiphoid   ligaments,   the   fingers 

*  The  average  normal  rate  of  respiration  is  about  eighteen  per  minute,  but  as  the 
need  of  aeration  is  urgent,  and  as  artificial  respiration  is  apt  to  be  less  efficient  than 
the  normal  function,  it  is  well  to  exceed  the  normal  rate  sUghtly. 

t  Atkinson.     American  Text-book  of  Applied  Therapeutics,  1896,  p.  37. 


ARTIFICIAL  RESPIRATION 


215 


falling  naturally  into  the  lower  intercostal  spaces.  Resting  his  elbow 
against  his  sides  and  using  his  knees  as  a  pivot,  he  throws  his  whole 
weight  slowly  and  steadily  forward  until  his  mouth  nearly  touches  the 
mouth  of  the  patient,  and  while  he  might  slowly  count  one,  two,  three; 
then  suddenly,  by  a  final  push,  springs  himself  back  into  his  first  erect 
position  on  his  knees;  he  remains  there  while  he  might  slowly  count  one, 
two,  then  repeats,  and  so  on  about  eight  or  ten  times  in  a  minute." 


Fig.  14. — Schafer's  prone-pressure  method  of  artificial  respiration,     a,  pressure 
being  applied;  b,  pressure  removed. 


The  Laborde  method  of  rhi^lbmic  traction  upon  the  tongue  may  be 
used  as  a  stimulant  to  respiratory  movements  when  there  is  any  possi- 
bility of  response,  the  tongue  being  grasped  by  the  fingers  over  a  drj' 
napkin,  or  by  a  tenaculum  or  forceps,  and  drawn  forcibly  forward  at 
intervals  of  about  four  seconds.  Laborde  holds  that  this  measm-e  excites 
reflexly  the  movements  of  the  diaphragm  especially. 

A  still  more  powerful  means  of  exciting  respiration  reflexly,  is  that 
of  rhythmically  stretching  the  sphincter  ani.    This  has  been  found  very 


216  ANESTHETICS 

useful  in  resuscitation  from  dangerous  anesthesia  and  from  opium 
poisoning. 

Medicinal  Teeatmext. — While  artificial  respiration  must  be  kept 
up  until  natural  respiration  is  restored,  or  until  the  hopelessness  of  the 
case  has  been  absolutely  established,  an  assistant  must  keep  note  of 
pulse  and  give  respiratory  and  cardiac  stimulants  hypodermically,  as 
required.  The  same  medicinal  treatment  will  be  indicated  here  as  in 
poisoning  by  cocaine,  being  careful  to  avoid  vasodilators,  especially 
where  the  arterial  pressure  is  greatly  reduced.     (See  Plate  IV,  p.  177.) 

Strychnine^  atropine,  caffeine  and  digitalis,  therefore,  will  be  the 
drugs  indicated,  the  last  named  being  less  needed  in  cases  of  simple 
asphyxia.  Meanwhile,  the  so-called  diffusible  stimulants,  such  as 
ammonia  by  inlialation,  or  aromatic  spirit  of  ammonia  by  the  mouth 
(y-1  teaspoonful  (2-4  mils)  if  swallowing  is  possible,  may  be  given. 
[The  suprarenal  preparations  (adrenalin,  etc.),  would  usually  be  classed 
with  these  arterial  stimulants;  but  in  case  of  danger  from  chloroform 
they  would  be  absolutely  contra-indicated,  because  of  their  peculiar  and 
dangerous  effect  upon  the  heart  under  chloroform.     (See  p.  207,  note.)] 

Alcohol. — Ethylic  Alcohol. — Spiritus  Vini  liectificatns  [C2H6O.] 
(For  preparations  and  doses,  see  Index  of  Drugs.)  In  alcohol  we  have 
an  anesthetic  agent  that  is  practically  not  used  as  such.  It  has  been 
commonly  regarded  as  a  stimulant,  but  a  study  of  its  full  action,  com- 
pared with  that  of  ether  and  chloroform,  must  convince  one  of  a  real 
similarity,  approaching  an  identity,  in  their  effects.  ^Yhatever  of 
stimulant  effect  it  induces  seems  to  be  secondary  to  its  local  irritant 
action;  in  this  respect  it  resembles  ether.  Its  full  anesthetic  effect  is 
so  slowly  produced  and  persists  so  long  and  is  attended  with  such  un- 
pleasant symptoms  (those  of  drunkenness),  that  it  cannot  ordinarily  be 
used  as  an  anesthetic.  That  it  is  a  poison  cannot  be  questioned.  That 
it  is  capable  of  acting  as  a  food  is  in  accordance  with  the  teaching  of  most 
authorities,  but  it  cannot  be  regarded  as  an  economical  food  in  health. 

Its  precise  action  after  absorption  into  the  blood  is  not  fully  under- 
stood, except  that  in  large  doses  it  is  anesthetic  and  poisonous.  This 
latter  fact  should  form  the  basis  of  a  positive  rule  that  alcohol  should  not 
be  given  in  dangerous  narcosis  from  ether  or  chloroform.  It  can  only 
be  admissible  as  a  reflex  stimulant,  or  as  present  in  the  aromatic  spirit 
of  ammonia  or  in  other  irritating  diffusible  stimulants.  (The  diagrams 
of  Plate  VIII  are  intended  to  show  the  present  status  of  knowledge 
concerning  the  internal  influence  of  alcohol.) 


PLATE    VIII- 

ALCOHOL. 

T'sed  commonly  in  the  foi'm  of 
Whisky,  Brandy,  or  Wine. 

Classified  as : 

Irritant.  Stimulant. 

Asti'ingent.  Narcotic. 

Antiseptic.  Anesthetic. 

PliysioJogic  action  : " 

To  summarize  the  physiologic 
effects  of  alcohol  is  very 
difficult,  owing  to  the  con- 
tradictory opinionsheld  hy  Skin\ 
good  authorities.  While 
most  writers  agree  that  the 
full  effect  of  a  large  dose 
of  the  drug  is  that  of  a 
general  depressant,  tliere  is 
no  agreement  as  to  the  in- 
fluence of  a  small  dose. 

Two  diagrams  are  here  presented : 
Diagi-am  A  represents  the  action  of  a  small  dose  as 
taught  by  those  who  liold  that  its  primai'y  influence 


PLATE    VIII.— B. 


includes  stimulation  of  th' 
cerebrum  and  of  the  heart. 

Diagram  B  shows  the  de- 
pressant action  of  a  large 
dose  upon  the  nervous 
system,  circulation,  and 
digestion.   Many  observers 

deny  the  primary  stimulant  action,  holding  that  the  drug  is  a 
depressant  from  the  first,  or  even  in  small  dose.  Tiie  excitement 
of  intoxication  is  not  due  to  Btimulation,  but  to  depression  of  the 
higher  controlling  centers. 

Local  action.'  Irritant,  by  reason  of  its  affinity  for  water.  When 
applied  to  the  mucous  membrane  of  the  digestive  tract,  the  ivi-i- 
tatiou  probably  induces  reflex  stimulation,  which  may  account 
in  part  for  the  primary  stimulant  effect  attributed  to  the  drug. 

Diycsiion.     In  small  doses,  well  diluted,  alcoliol  seems  to  increa 
gastric  secretion  and  motility,  wliile  stronger  solutions  (5  per 
cent,  or  more)  retard  tbe  digestiv 

-Is  IX  food  the  position  of  alcohol  has  not  been  very  definitely 
determined.  A  small  part  only  can  be  recovered  as  alcohol 
from  the  fluids  of  excretion.  The  gi-eater  part  therefoi-e  is 
changed  into  other  products,  and  is  believed  thereby  to 
tribute  some  energy  to  the  body.  The  economy  to  the  system 
of  its  use  may  be  open  to  question. 

Metabolism,  Its  influence  upon  nutritive  changes  and  upon  elimi- 
nation is  uncertain. 


CHAPTER  XV. 
STIMULANTS  AND  TONICS. 

STIMULANTS. 

A  STIMULANT  IS  usually  defined  to  be  an  agent  that  increases  the  activity 
of  an  organic  function  or  process.  But  in  the  application  of  the  principle 
of  stimulation,  a  qualification  of  this  definition  should  be  noticed.  We 
seek  not  simply  to  secure  rapidity,  but  always  efficiency  of  a  function. 
Thus,  in  the  majority  of  cases  that  call  for  a  heart  stimulant  the  heart's 
action  is  already  rapid,  and  our  most  powerful  stimulants,  such  as 
digitalis,  in  their  full  action  actually  slow  the  pulsations  of  the  heart; 
but  in  spite  of  this  the  efficiency  of  the  contraction  is  increased  by 
them  and  the  pulse  improved  in  character.  Again,  the  efficiency  of  a 
function  may  be  lessened  by  undue  inhibitory  restraint.  Here  a  stimu- 
lant result  would  require  that  the  inhibitory  influence  be  weakened. 
Belladonna  acts  in  such  manner,  allowing  the  heart  to  beat  more  rapidly 
by  depressing  the  inhibitory  vagus  nerve  endings. 

Having  in  mind,  therefore,  the  real  object  of  stimulation,  i.  e.,  to 
secure  efficiency  of  a  function,  we  may  employ  agents  that  act  in  various 
ways,  but  always  toward  the  same  object. 

Direct  stimidants  have  their  action  directly  upon  the  organ  or  tissue 
sought  to  be  influenced.  Their  action  may  be  to  increase  nervous, 
muscular  or  secretory  activity.  Such  an  agent  might  be  called  a  kinetic 
stimulant,  in  that  it  changes  latent  into  active  energy.  This  increase 
of  activity  is  at  the  expense  of  the  reserve  energy  of  the  organ,  and  tends 
toward  its  exhaustion.  This  is  an  important  consideration  in  the  choice 
of  a  stimulant,  and,  indeed,  in  the  decision  whether  any  stimulant  shall 
be  employed,  for  the  rapid  exhaustion  of  the  reserve  power  of  an  organ 
may  defeat  the  object  of  our  stimulation. 

There  are  some  stimulants,  however,  to  which  this  objection  scarcely 
applies — those  that  simply  increase  the  irritability  of  nerve  or  muscle 
without  calling  forth  any  increase  of  activity,  except  in  response  to 
normal  stimuli.  These  might  be  called  potential  stimulants,  in  that  they 
increase  the  possibility  of  activity  in  response  to  normal  stimuli.  They 
do  not  tend  particularly  toward  exhaustion  of  an  organ.     Strychnine  is 


218  STIMULANTS  AND   TONICS 

a  stimulant  of  this  kind,  its  action  being  to  increase  the  irritability  of 
nerve  centers. 

Indirect  stinmlants  produce  the  stimulant  result  secondarily.  Some 
of  these  act  primarily  by  removing  inhibitory  influence  and  others  by 
causing  an  irritation  of  sensory  nerves.  An  example  of  the  former  is  the 
belladonna  action,  noted  above,  which  primarily  lessens  the  inhibitory 
influence  of  the  vagus  upon  the  heart,  and  thereby  allows  the  heart  to 
beat  more  rapidly,  which  is  the  secondary  or  indirect  stimulant  eflFect. 
Examples  of  the  latter  are  ammonia,  alcohol  and  ether,  which  are 
locally  irritating  to  mucous  membranes.  By  irritating  sensory  nerve 
endings,  they  induce  a  reflex  or  indirect  stimulant  effect. 

Some  stimulants  are  poisonous  when  given  in  excessive  dosage;  and 
the  symptoms  of  toxic  disturbances  usually  include  delirium  or  con- 
vulsions. 

(Because  of  the  sensitiveness  of  the  system  in  childhood,  children  do 
not  bear  stimulants  as  well  as  sedatives.  They  need  stimulation  less  often 
than  do  older  persons,  and  the  response  to  stimulants  is  usually  prompt.) 

The  Indication  for  Employing  Stimulants  is,  in  general,  any  depression 
of  a  function  to  a  degree  that  may  be  regarded  as  below  the  yhysiologic 
minimum  of  its  activity.  ^Ye  recognize  that  every  organ  has  a  certain 
range  of  action  that  may  be  called  physiologic,  within  which  it  reacts  to 
the  work  demanded  of  it,  by  increasing  or  lessening  its  activity.  Func- 
tional activity,  therefore,  is  a  variable  quantity,  based  upon  the  strength 
and  nutritive  resources  of  an  organ,  which  are  opposed  by  the  amount  of 
work  imposed  upon  it.  The  physiologic  minimum  of  activity,  therefore, 
must  vary  as  modified  by  these  factors;  but  it  may  be  defined  to  be  the 
minimum  of  efficiency  of  a  function  under  existing  conditions.  Now  as 
long  as  an  organ  is  working  efficiently  within  its  physiologic  range  it 
needs  no  stimulation.  But  when,  either  from  its  own  inability  or  from 
excessive  demands  made  upon  it,  its  activity  falls  below  its  physiologic 
minimum,  then  stimulation  may  be  employed  to  compel  an  extra  ex- 
penditure of  energy  in  enforced  activity. 

It  is  observed,  moreover,  that  normally  acting  organs  do  not  show 
much  response  to  stimulants,  but  that  those  whose  action  is  deficient 
respond  well.  When  an  organ  is  doing  all  the  work  that  is  required  of 
it,  it  is  difficult  to  force  its  action;  but  when  the  need  of  doing  more  work 
is  present  and  a  stimulant  is  applied,  there  appears  to  be  a  cooperation 
of  factors,  the  increased  irritability  or  the  more  fowerfnl  iminession 
contributed  by  the  applied  stimulant  enabling  the  organ  to  respond  to 
the  need  of  increased  work,  which,  after  all,  is  its  normal  stimulus. 


STIMULANTS  219 

Thus  defined  and  limited,  stimulants  form  a  very  important  and 
indispensable  class  of  remedies — the  kinetic  stimulants  to  serve  as 
emergency  remedies  to  tide  an  organ  over  a  critical  period,  and  the 
'potential  class  to  forestall  failure  of  its  function.  Closely  related  to  the 
latter  are  the  agents  usually  classed  as  tonics,  which  may  supply  elements 
to  the  tissues  or  conserve  the  expenditure  of  energy  by  the  cells. 

Irritant  Stimulants. 

The  indirect  stimulants  that  produce  a  prompt  circulatory  effect 
have  been  termed  diffusible  stimulants.  They  are  diffusible  in  effect 
rather  than  in  action.  Their  action  is  mostly  a  reflex  one,  following 
local  irritation  of  the  sensory  nerves  in  the  mucous  membrane.  Their 
effects  are  usually  transient. 

Alcohol  fethylic). — The  local  action  of  this  drug  is  fully  considered 
in  the  chapter  on  Astringents;  but  the  secondary  effects  arising  from  the 
marked  irritation  that  attends  its  abstraction  of  water  from  the  tissues 
and  its  coagulation  of  albumin,  are  those  that  may  be  called  stimulant. 
They  are  reflex  in  nature,  and  are  similar  to  the  reflex  effects  following 
irritation  of  any  sensory  nerve.  Alcohol  should  be  used  in  a  strength  of 
not  less  than  50  per  cent.,  in  order  to  obtain  the  stimulant  effect,  which 
at  best  is  slight  and  transient.  It  may  be  used  either  diluted  or  in  the 
form  of  whisky  or  brandy.  Pharmacologic  experiments  upon  dogs  do 
not  prove  alcohol  to  be  a  stimulant  after  its  entrance  into  the  circulation; 
there  may  be  a  slight  temporary  increase  of  pulse-rate^  but  arterial 
pressure  is  not  raised. 

On  the  whole,  alcohol  must  rank  as  a  rather  feeble  reflex  stimulant, 
whose  effect  is  uncertain  and  brief,  and  requiring,  for  continued  effect, 
repeated  doses  that  may  later  cause  depression.  For  a  single,  prompt 
stimulant  result,  as  in  case  of  faintness,  it  is  often  useful. 

It  should  be  remarked  that  what  is  popularly  regarded  as  stimulation 
by  alcohol,  i.  e.,  the  hilarity,  activity  and  talkativeness,  are  not  stimulant 
effects  at  all,  but  rather  the  opposite.  They  correspond  to  the  period  of 
disturbed  or  imperfect  consciousness  common  to  anesthetics,  and  must 
be  regarded  as  uncontrolled  activity  of  the  lower  emotional  and  reflex 
centers,  which  occurs  because  the  controlling  function  of  the  cerebrum 
has  been  depressed. 

In  large  doses  alcohol  soon  produces  its  characteristic  depression  of 
the  whole  central  nervous  system,  while  its  continued  use  leads  to  degen- 
erative changes  in  the  arterial  system,  kidneys,  liver  and  other  highly 
vascular  organs. 


220  STIMULANTS  AXD   TOXICS 

^ther. — Ether. — This  drug  is  fully  considered  in  the  chapter  on 
Anesthetics.  Its  stimulant  secondary  effects,  following  primary  irri- 
tation, are  similar  to  those  of  alcohol.  It  is  used  in  the  following 
preparations : 

Spiritus  ^theris. — Spirit  of  Ether. — (contains  325  parts  of  ether  and  675 
parts  of  alcohol.)     Average  dose  f3  1  (4  mils). 

Spiritus  .ffitheris  Compositus. — Compound  Spirit  of  Ether. — Hoffman's 
Anodyne  (contains  325  parts  of  ether,  650  parts  of  alcohol  and  25  parts  of  ethereal 
oil.     Not  official.)     Dose  f3  1  (4  mils). 

These  preparations  are  given  mostly  by  the  stomach.  Ilypodermically 
they  are  quite  irritating,  although  this  should  not  prevent  their  use  in 
emergency,  if  swallowing  is  difficult  or  impossible.  Indeed,  the  greater 
irritation  would  likely  induce  greater  reflex  stimtdation. 

Ammonia  [XII3]. — (For  all  preparations  see  Index  of  Drugs.)  This 
substance  has  a  decidedly  irritant  local  action,  and  has  the  advantage 
of  being  a  gas,  which  permits  of  inhalation.  It  is  so  volatile  that  it  is 
always  employed  in  solution,  even  for  inhalation.  In  fact,  the  aqua 
ammonice  fortior  liberates  the  gas  so  rapidly  as  to  be  caustic  in  action, 
and  is  therefore  not  to  he  employed  in  any  way  as  a  stimulant,  unless  first 
diluted.    The  following  preparations  are  commonly  employed: 

Aqua  Ammoniae. — Water  of  Ammonia. — (contains  10  per  cent,  by  weight  of 
the  gas  in  water.)     Average  dose  TH,  15  (1  mil)  diluted. 

Spiritus  Ammoniae  Aromaticus. — Aromatic  Spirit  of  Ammonia.* — Average 
dose  m  30  (2  mils). 

The  aromatic  spirit  of  ammonia  is  the  best  one  of  this  class  of  stimu- 
lants for  stomach  administration.  Its  stimulant  action  is  of  longer 
duration  because  of  the  gradual  decomposition  of  the  ammonium  car- 
bonate, which  thus  liberates  ammonia  gas  for  some  time.  All  ammonia 
preparations  deteriorate  with  keeping  unless  kept  tightly  corked.  Of 
the  salts  of  ammonium  the  carbonate  is  a  valuable  stimulant. 

Miscellaneous  Stimulants. 

Various  other  volatile  substances  ha\e  a  more  or  less  direct  stimulant 
action,  the  reflex  factor  being  much  less  because  they  are  less  irritating. 
The  volatile  oils  and  substances  related  to  them  belong  to  this  class. 
A  few  only  among   them    are    important    enough    to    be    employed. 

*  Aromatic  spirit  of  ammonia  contains:  Water  of  ammonia,  9  per  cent.;  carbonate 
of  ammonium,  3.4  per  cent.,  and  small  quantities  of  oils  of  lemon,  lavender  and 
nutmeg,  with  alcohol,  70  per  cent. 


STIMULANTS  221 

These  are  stimulating  to  the  central  nervous  system  and  to  the  heart. 
In  large  doses  they  may  depress.  Locally  some  are  irritating,  while 
others  are  sedative.  They  are  much  used  internally  as  carminatives, 
i.  e.,  agents  that  relieve  colic  and  cause  expulsion  of  gas  by  relieving 
spasmodic  contraction  of  the  intestines. 

Camphora. — Camphok  [doHieO]. — Average  dose  gr.  3  (0.2  gm.). 
A  ketone  derived  from  Cinnamomun  camphora.  It  occurs  in  white, 
translucent,  crystalline  masses,  which  are  soluble  in  alcohol,  ether, 
chloroform,  and  oils,  but  almost  insoluble  in  water.  It  has  a  strong  odor 
and  sharp  aromatic  taste.  It  is  tough,  but  may  be  pow^dered  in  the 
presence  of  a  little  alcohol.  (For  preparations  and  doses,  see  Index  of 
Drugs.) 

Locally,  camphor  preparations  are  sedative  except  for  the  alcohol 
present  as  the  solvent.  Internally,  it  is  a  general  stimulant  to  the 
nervous  system  and  heart,  but  in  large  doses  it  may  depress  the  brain, 
so  as  to  cause  delirium  or  convulsions.  The  spirit  may  be  inhaled  in 
syncope  or  faintness. 

For  internal  use  as  a  stimulant,  camphor  has  acquired  a  place  of  first 
importance  in  the  treatment  of  circulatory  depression.  It  is  given  hypo- 
dermically,  dissolved  in  a  sterile  fixed  oil. 

For  local  application  certain  combinations  which  modify  the  action 
of  camphor  are  sometimes  used.  The  basis  for  these  is  the  fact  that 
when  camphor  is  triturated  with  either  phenol,  chloral  hydrate,  menthol 
or  thymol,  the  mixture  becomes  liquid  and  is  suitable  for  external  use. 
Of  these.  Camphorated  phenol  (Camphophenique)  and  Camphorated 
chloral  are  most  frequently  employed. 

Spiritus  Camphorse. — Spikit  of  Camphor. — Contains  10  per  cent,  of 
camphor  in  alcohol.    iVverage  dose,  lU  15  (1  mil). 

Oleum  Menthse  Piperitse. — Oil  of  Peppermint. — Average  dose,  lU  3 
(0.2  mil).  This  is  used  mostly  as  a  carminative,  either  in  form  of  the 
spirit,  or  combined  with  cathartics  to  prevent  griping.  The  local  effect 
is  sedative. 

Heat. — The  stimulant  effect  of  heat  is  made  use  of  in  various  ways. 
In  case  of  shock  or  collapse  a  hot-water  bag  placed  directly  over  the 
heart,  or  heat  applied  to  the  extremities,  will  be  found  useful.  Copious 
injections  of  very  warm  water,  or  preferably  warm  normal  salt  solution, 
into  the  rectum  and  colon,  is  a  very  excellent  means  of  stimulation  by 
heat.    The  restorative  value  of  the  salt  is  also  here  apparent. 

Liquir  Sodii  Ohloridi  Physiologicus. — Normal  Salt  Solution. — This 
contains  0,85  per  cent,  of  sodium  chloride  in  sterile  water.    Its  use  by 


222  STIMULANTS  AND   TONICS 

hypodermoclysis,  or  intravenously,  should  be  regarded  today  as  one  of 
the  most  important  means  of  stimulation.  It  is  rather  restoration,  by  a 
fluid  corresponding  closely  in  salinity  to  the  blood  serum,  which  may  be 
deficient  or  improperly  distributed.  Loss  of  blood  by  hemorrhage  or 
loss  of  serum  by  a  serous  diarrhea,  would  especially  indicate  the  use  of 
saline  solution.  It  is  also  useful  in  any  condition  of  extreme  depression. 
In  severe  cases  of  typhoid  fever  and  other  exhausting  diseases,  the 
patient  is  oftentimes  tided  over  a  critical  period  which  might  otherwise 
be  fatal,  by  the  daily  use  of  one  to  four  pints  of  normal  salt  solution 
hypodermically.  The  solution  is  prepared  quite  hot  and  allowed  to  run 
slowly  through  a  large-sized,  long  hypodermic  needle  from  a  fountain 
syringe  into  the  lumbar  region  or  underneath  the  breast.  Other  stimu- 
lants may  be  added  to  the  solution. 

Belladonna — Atropina  [0171123X03].     (Plate  IX,) 

Belladonnce  Folia.  BelladonnoB  Radix. — This  drug  holds  a  unique 
place  as  being  a  central  stimulant  and  peripheral  depressant  to  the 
nervous  system.  Either  the  alkaloid  atropine  or  the  tincture  of  bella- 
donna may  be  used  as  a  respiratory  and  cardiac  stimulant,  atropine  being 
always  preferred  for  hypodermic  use.  But  this  drug  must  be  regarded 
as  a  second-rate  stimulant,  and  care  must  be  taken  not  to  exceed  the 
physiologic  limit,  as  it  may  then  be  disturbing  or  narcotic  in  effect. 
Locally  applied,  belladonna  is  anodyne,  acting  by  depressing  sensory 
nerve  endings.  It  is  used  to  allay  local  pain  or  irritation,  as  in  neu- 
ralgia, for  which  purpose  the  plaster,  ointment,  or  liniment  of  bella- 
donna, or  the  oleate  of  atropine  may  be  applied.  (For  preparations 
and  doses,  see  Index  of  Drugs.) 

Atropine  in  aqueous  solution  is  dropped  into  the  eye  to  dilate  the 
pupil  and  to  paralyze  accommodation.  Any  preparation  of  belladonna 
or  atropine  promptly  checks  the  excessive  flow  of  saliva  in  mercurialism, 
for  the  treatment  of  which  symptom  it  is  our  best  agent.  Sweating  is 
also  diminished  by  this  drug,  as  are  also  various  other  secretions  of  the 
body.  In  checking  secretion  the  drug  acts  by  paralyzing  the  secretory 
nerve  terminals  within  the  glands. 

The  official  salt  of  the  alkaloid  is  Atropinse  sulphas. — Average  dose 
gr.  j^^  (0.0005  gm.). 

The  following  alkaloids  have  an  action  somewhat  similar  to  that  of 
atropine : 


PLATE  IX. 


PLATE  IX 


BELLADONNA. 

Leaves  and  root  of  Atropa  B.     The  alkaloid  Atropine  represents  tlia  drng  fiiHy. 


Classified  as : 

Cerebral  stimulant. 
Cardiac  stimulant. 


Deli  riant  narcotic. 
Anodyne. 


Mydriatic. 
Antiliidrotic. 


Physiologic  action : 
In  general,  ''  atropine  acts  as  a  stimulant  to  the  central  nervous  system  and  paralyzes  the 
terminations  of  a  number  of  the  nerves,  more  especially  of  those  that  supply  invol- 
untary muscle,  secretory  glands  and  the  heart."  [Cushny.]  It  paralyzes  peripheral 
inhibition.  It  decreases  the  secretions  generally,  except  the  urine,  and  increases  the 
body  tempeiuture,  producing  a  condition  simulating  fever. 
Nervous  System. 

Brain.     Stimulates  the  cerebrum,  especially  in  its  motor  areas. 
Medulla.     Stimulates  respiratory  center. 
Spinal  cord.     Depresses  inhibitory  centei-s. 


Sensory.     Depresses  sensory  nerve  endings. 
Motor.     Depresses  motor  nerves. 

Secretory.     Paralyzes  the  endings  of  many  of  the  secretory  nerves,  censing  a  diminu- 
tion or  arrest  of  the  secretion ;  hence  there  result  dryness  of  the  mouth,  le.ssened 
secretion  of  gastric  and  pancreatic  jiiices  and  of  milk.    The  sweat  glands  are  rendered 
less  active. 
Vagus.     Paralyzes  the  inhibitory  terminations  of  the  vagus  within  the  heart,  and  the 
secretory  terminations  withm  the  digestive  system. 
Muscular  System.     Depresses  unstiiped  muscle,  but  has  no  influence   upon   voluntary 
muscle.     Lessens  the  movements  of  stomach,  intestines,  bladder,  uterus,  and  in  gen- 
eral the  organs  containing  unstriped  muscle,  except  the  arterial  walls.     [Cushny.] 
Eye.     Pupils  are  dilated  by  paralysis  of  terminals  of  the  motor  oculi  nerve  in  the  iris, 
whereby  it  paralyzes  accommodation  also.    Most  authorities  state  that  it  increases  in- 
traocular pressure. 
Circidalion.    Arterial  pressure  is  increased,  chiefly  by  its  action  upon  the  heart. 
Heart.     Increases  pulse  rate  by  paralyzing  inliibition  (peripheral  ends  of  vagus).     The 

heart  muscle  or  its  accelerator  nerves  may  feebly  be  stimulated. 
Rtapiralion.     Stimulated  by  action  upon  respiratory  center. 

Excretion.     Perspiration  is  lessened.     The  drug  is  excreted  rapidly  by  the  kidneys,  but 
its  influence  upon  their  activity  is  uncertain. 


The  red  color  indicates  stimulation,  and  the  blue  color  depression. 


PLATE     X 


CAFFEINE 

An  alkaloid  existing  in  coflfee, 
tea,  guarana,  and  cola  nut. 


Classified  as : 

Cerebi-al  stimulant. 
Cardiac  stimulant. 
Respiratory  stimulant. 
Diuretic. 

Physiologic  action : 

Nervous  System. 

Cerebrum.  Stimulates 
cortex,  increasing  liie  ac- 
tivity of  psychic  func- 
tions. 
Medulla.  Stimulates  res- 
piratory center  and  vaso- 
motor center.  Yagus  cen- 
ter may  be  stimulated, 
but  the  effect  masked  by 
the  direct  effect  upon  the 
heart. 

Muscular  System.      Irritability   and    working   power   of    muscle 
tissue  increased. 

Circulation.    Arterial  pressure  may  be  increased  slightly  by  vaso- 
motor activity. 

Heart.  Stimulates  heart  muscle,  tending  to  produce  accelera- 
tion of  the  pulse. 

Capillary  area.    Tends  to  contract  arterioles  by  stimulation 
of  vasomotor  center  in  the  medulla,  but  this  action  is  largely 
neutrallized  by  dilatation  of  the  systemic  arterioles  by  per- 
ipheral action. 
Excretion. 

Kidneys.  Stimulates  excretory  function,  both  of  the  glom- 
eruli and  the  renal  epithelium,  causing  increase  of  water 
and  of  solids,  the  increase  of  water  being  more  marked. 
The  diuretic  effect  may  be  prevented  by  the  vasomotor 
action. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


The  red  color  indicates  stimulation 
by  Caffeine. 


PLATE    XI. 


IVUX   VOMICA. 

The  seeds  of  Strychnos  Nux  V. 

The  alkaloid  Strychuine  repre- 
sents the  drug  fully. 


Classified  as  : 

Bitter  tonic. 
Cardiac  stimulant. 
Nerve  stimulant. 
Excitomotor. 

Physiologic  action  : 

Digestive  Tract.  Stimulates  se- 
cretion of  gastric  juice 
and  motility  of  stomach 
and  intestines. 

Nervous  System. 

Cerebrum.  No  effect  upon 
cortex.  Consciousness  not 
influenced.  Special  senses 
rendered  more  acute. 

Medulla.  Stimulates  res- 
piratory and  vasomotor 
centers.  Vagus  center  may- 
be slightly  stimulated. 

Spinal  cord.  Increases  reflex  irritability  of  the  cord  in  its 
whole  extent. 

Circulation.     Arterial  pressure  increased. 

Heart.  It  is  believed  to  stimulate  either  heart  muscle  or 
cardiac  ganglia,  or  both. 

Capillary  area.  The  splanchnic  arterioles  may  be  con- 
tracted by  its  action  upon  vasomotor  centers,  but  the  cuta- 
neous and  muscular  vessels  tend  to  dilate. 

Excretion.  Eliminated  by  the  kidneys,  appearing  soon  after  ab- 
sorption, partly  unchanged  and  partly  changed.  Contraction 
of  renal  vessels  may  hinder  its  elimination. 


Vagus  Center 

Vase  Motor 

Center 
Cervical 
Sympathetic 


The  red  color  indicates  the 
stimulant  action  of  Nux 
Vomica  or  Strychnine. 


STIMULANTS  223 

Homatropinse  Hydrobromidum,  an  artificial  alkaloid,  is  used  as  a 
mydriatic,  producing  a  more  rapid  and  more  transient  dilatation  of  the 
pupil  than  does  atropine.    It  is  used  locally.    (See  Index  of  Drugs.) 

Hyoscyaminae  Hydrobromidum,  average  dose  gr.  2^^^  (0.0003  gr.). 
Obtained  from  Hyoscyamus  and  other  Solanacece.    Used  as  sedative. 

Scopolaminae  Hydrobromidum  (Hyoscinse  Hydrobromidum),  average  dose 
gr.  2-^0"  (0.0003  gm.).  Obtained  from  Hyoscyamus  leaves,  Scopola  root 
and  other  Solanaceoe.  This  is  less  stimulating  than  atropine;  in  fact, 
is  used  only  as  hj^notic  and  sedative.     (See  Index  of  Drugs.) 

Caffeina.     Caffeine  [CgHioNA+HaO].     (Plate  X.) 

Caffeina  Citrata. — Citrated  Caffeine. — Average  dose,  gr.  5  (0.30 
gm.).  This  alkaloid,  obtained  from  tea  and  coffee,  has  an  important 
use  as  a  heart  and  cerebral  stimulant  and  as  a  diuretic.  It  is  entirely 
safe  to  be  used  in  large  doses,  therefore  it  is  one  of  the  best  stimulants 
to  employ  in  poisoning  by  narcotics.  The  citrated  caffeine  is  the  prep- 
aration usually  employed,  because  more  soluble  than  caffeine.  (See 
note  on  p.  177.) 

CaflEeinae  Sodio-Benzoas. — Caffeine  Sodio-benzoate. — Average  dose 
by  mouth,  gr.  5  (0.30  gm.).  hj-podermic,  gr.  3  (0.20  gm.).  This  is  the 
best  salt  of  caffeine  for  hypodermic  use,  because  of  its  free  solubility  in 
water,  being  soluble  in  1.1  parts. 

Theobromine  (from  Theobroma  cacao  and  from  Guarana)  has  an  action 
upon  the  circulation  similar  to  that  of  caffeine,  but  is  superior  as  a 
diuretic,  and  less  stimulating  to  the  cerebrum.     (Not  official.) 

Nux  Vomica— Strychnina  [C21H22N2O2].     (Plate  XI.) 

(For  preparations  and  doses,  see  Index  of  Drugs.) 

This  drug  easily  ranks  as  one  of  the  very  best  general  stimulants.  In 
large  doses  it  is  poisonous,  but  it  is  not  narcotic,  therefore  it  can  be 
pushed  to  its  physiologic  limit  with  less  danger  than  is  the  case  with 
belladonna.  It  increases  the  irritability  of  nerve  centers  to  normal 
stimuli,  and  does  not  tend  directly  to  exhaustion.  It  is  a  valuable 
respiratory  stimulant  by  action  upon  the  centers. 

In  all  conditions  of  general  depression,  cardiac  weakness,  in  infectious 
diseases,  pneumonia,  typhoid  fever,  in  poisoning  by  cocaine,  opium  and 
other  narcotics,  it  is  useful.    It  is  also  used  as  a  bitter,  stomachic  tonic. 


224  STIMULANTS  AND   TONICS 

Internally  any  preparation  may  be  given.  Hypodermically  a  salt  of 
the  alkaloid  strychnine  is  employed.    The  official  salts  of  strychnine  are: 

Strychninae  Nitras. — Average  dose,  gr.  4,3  (0.0015  gm.). 

Strychninae  Sulphas. — Average  dose,  gr.  ^^  (0.0015  gm.). 

(For  symptoms  and  treatment  of  poisoning  by  strychnine,  see  Table 
of  Poisons  and  Antidotes.) 


Digitalis.     (Plate  XII.) 

(For  preparations  and  doses,  see  Index  of  Drugs.) 

Digitalis  is  used  whenever  the  heart  is  unequal  to  its  task,  by  reason 
of  dilatation  or  simple  weakness.  When  extensive  fatty  degeneration 
is  present,  and  in  certain  valvular  defects,  it  is  not  the  drug  of  choice, 
but  may  be  required.  As  it  "whips  up"  the  heart  to  greater  exertion,  its 
use  should  be  discontinued  as  soon  as  possible,  so  as  to  avoid  exhaustion 
of  the  organ.  It  should  be  regarded  as  an  emergencii  drug  in  cardiac 
diseases.  It  is  a  great  mistake  to  suppose  that  digitalis  is  needed  in 
every  case  of  valvular  disease;  for  when  any  cardiac  disease  is  fully 
compensated,  and  in  simple  hypertrophy,  digitalis  should  not  be  used. 
When  arterial  pressure  is  high  the  drug  is  not  indicated.  In  these  con- 
ditions the  drug  may  do  harm.  The  tincture  and  the  infusion  are  the 
preparations  mostly  employed.  In  emergency  the  tincture  may  be  used 
hypodermically  in  full  dose.  The  drug  acts  slowly,  and  it  therefore 
cannot  be  relied  upon  alone  as  an  emergency  stimulant. 

Strophanthus,  a  drug  that  acts  similarly  to  digitalis,  is  used  as  a  sub- 
stitute for  it. 

(For  preparations  and  doses,  see  Index  of  Drugs.) 


Nitrites.     (Plate  XIII.) 

The  nitrites  are  indicated  in  conditions  of  high  arterial  pressure,  due 
to  disease  of  the  arteries  or  constriction  of  arterioles.  They  cannot  be 
regarrled  as  direct  heart  stimulants  of  any  decided  power,  but  they  act 
in  an  equivalent  way,  by  reducing  the  work  of  the  heart  through  dilating 
the  arterioles.  In  this  way  the  resistance  against  which  the  heart  has 
to  force  the  blood  is  largely  removed,  and  at  the  same  time  its  action 
is  accelerated,  so  that  a  freer  capillary  supply  results.  Nitrites  should 
not  l)e  used  in  conditions  of  low  arterial  pressure.  Nitroglycerin  in 
tablet  form,  or  its  1  per  cent,  solution  {Spiritus  Glyceryl  is  Nitmtis)  is 


PLATE    XII. 


DIGITALIS. 

The  leaves  of  D.  Purpurea. 


Note. — The  description  below 
is  of  the  action  of  the  drug  or  of 
preparations  fully  representing  it. 


Classified  as: 

Cardiac  stimulant. 
Cardiac  tonic. 
Diuretic. 


Physiologic  action  : 

Stomach.  Absorbed  slowly. 
Irritant  in  large  doses  or 
when  long  continued. 

Nervous  System. 

Brain.     No  influence  upon 

the  cerebrum. 
Medulla.     Stimulates  vagus  centers. 

Circulation.    Gives  greater  force  and  rapidity  to  arterial  current. 

Heart.  Stimulates  the  inhibitory  influence  (vagus,  center), 
which  slows  the  heart  and  tends  toward  relaxation.  Stimu- 
lates the  cardiac  muscle  and  contained  ganglia,  giving  greater 
force  to  the  contractions. 

Capillary  area.  No  direct  action  in  therapeutic  doses. 
With  improved  circulation  in  the  brain,  from  the  heart 
stimulant  effect,  relaxation  of  arterioles  occurs  which  pre- 
vents any  great  increase  of  blood  pressure. 

Excretion. 

Kidneys.  Direct  action  upon  the  renal  epithelium  is  uncer- 
tain. The  urine  is  increased,  but  mainly  through  the  in- 
fluence of  an  improved  circulation. 


Vagus  Center 

Vaso  Motor 

Center- 
Cervical 
Symjiathetic 


Solar  Plexus 


The  red  color  indicates  the 
stimulant  action  of  Digitalis. 


PLATE    XIII. 


^iTITRITES. 

A-MYI.    XlTEITE, 

1TL  1-5  (Gm.  .06-.30). 
NiTROGLYCEEi^r  {Glonotn,  Trinir 
trin). 

i77-7TV(Gra.  .OOOo-.OOl). 


Arterioles 
dilated 

^Section 


gi--  T 
Spieitus  Glycerylis  jS^ITKA- 
Tis,  1  per  cent.  Nitroglycerin. 
TTL  ^2  (Gm.  .03-.12J. 

SODITTJI  iSTlTEITE, 

gr.  1-3  (Gm.  .06-.20). 

Classified  as : 

Vasodilators. 
Circulatory  stimulants. 

Physiologic  action : 

While  the  action  of  the  ser- 
eral  drugs  of  this  group  is  rery  similar,  Amyl  Nitrite 
(by  inhalation)  has  the  most  rapid  and  transient  effect, 
Nitroglycerin  is  most  powerful,  and  Sodium  Nitrite 
has  the  most  permanent  etiect. 

Nervous  System. 

Brain.     No  direct  influence  iipon  cerebrum. 

Medulla.     Vagus  center  is  indirectly  depressed. 
Muscular  System.     Paralyzes  the  muscular  coats  of  the  arterioles 

and  veins  by  direct  action. 
Circulation.     Causes  a  decided  fall  in  arterial  pressure  ■n"ith  accel- 
eration of  the  pulse. 

Heart.  Any  direct  action  upon  the  heart  is  doubtful.  The 
acceleration  is  due  mainly  to  depression  of  the  vagus  center 
through  lessened  blood  pressure. 

Capillary  area.  DUates  arterioles  and  veins,  thereby  in- 
creasing the  volume  and  efficiency  of  the  capillary  circula- 
tion; vessels  of  face  and  abdominal  organs  are  most  affected. 

The  influence  upon  arterial  pressure  and  pulse  rate  is  shown  by 
the  following  sphygmographic  pulse  tracings: 


Vagus  Center 

Vase  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


Normal  pulse  tracing.     Eate84;  blood  pressure  normal. 


blood  pressure 


The  same  after  taking  Nitroglycerin.     Eate  96 
greatly  reduced. 


The  red  color  indicates  the  stimulant  effects  of  the  nitrites ;  the 
blue  color  indicates  their  depressant  action  upon  the  vagus 
center,  which  is  the  chief  cause  of  the  increase  in  pulse  rate. 

Note. — The  blood  changes  produced  in  animals  by  Amyl  Nitrite  are  not  seen  in  man  fol- 
lowing therapeutic  dosage. 


STIMULANTS  225 

commonly  employed.     It  is  the  best  l•ep^esentati^■e  of    the  group  of 
nitrites. 

It  is  not  necessary  to  give  nitrites  h\-podermically,  as  the  effect  of 
AiViYL  NITRITE  may  be  obtained  almost  instantly  by  inhalation,  and  a 
tablet  of  nitroglycerin  placed  under  the  tongue  will  produce  its  effect 
in  from  tlii'ee  to  five  minutes.  Its  action  also  completely  disappears  in 
from  thirty  to  sixty  minutes.  "When  the  drug  is  really  indicated  it  may 
be  given  every  hoiu"  for  several  doses  if  necessary,  or  the  dose  may  be 
increased  as  needed. 

Sodium  Nitrite  is  employed  when  a  slower  but  more  sustained  effect 
is  desired. 

In  conditions  that  are  believed  to  be  due  to  arterial  spasm  or  con- 
striction, as  angina  pectoris  and  asthma,  the  nitrites  are  useful  for 
temporary  relief;  and  in  arteriosclerosis  they  sometimes  constitute  the 
principal  medicinal  treatment. 

There  is  no  doubt  that  the  value  of  the  nitrites  was  earlier  over- 
estimated. Upon  the  plain  indications  mentioned  above  they  occupy 
a  place  of  usefulness  that  is  their  own,  no  other  drugs  being  comparable 
to  them;  but  it  was  unfortunate  that  the  belief  became  current  that 
they  were  direct  heart  stimulants.  For,  with  this  belief  as  a  basis,  they 
were  used  in  such  diseases  as  pnemnonia  and  other  acute  infectious 
diseases,  when  the  blood  pressm-e  was  already  too  low  to  allow  efficiency 
of  circulation,  and  in  cases  of  chloroform  narcosis,  where  the  same  con- 
dition prevailed.  In  fact,  it  was  the  practice  of  some,  the  more  cardiac 
stimulation  was  needed,  the  more  to  resort  to  the  nitrites;  while  it  is 
true  in  the  main  that  the  more  cardiac  stimulation  is  needed  the  less 
are  the  nitrites  indicated. 

The  nitrites  should  be  viewed  as  vasodilators,  not  as  heart  stimulants. 
But  in  their  action  as  vasodilators  they  may  be  regarded  as  circulatory 
stimulants.  The  capillary  area  fed  by  the  arterioles  is,  after  all,  the  most 
important  part  of  the  circulation,  for  it  is  there,  in  the  cells  of  the  tissues, 
that  all  nutritive  changes  occur  and  all  functional  activity  is  maintained. 
In  conditions  of  high  arterial  pressure,  the  blood  supply  to  the  capil- 
laries is  often  lessened  by  the  tendency  to  constriction  of  the  arterioles. 
The  nitrites,  by  dilating  the  arterioles,  will  increase  the  blood  supply 
to  the  capillary  area  and  furnish  better  nutritive  materials  for  cell 
activity — a  true  circulatory  stimulation,  but  not  heart  stimulation. 

It  is  worthy  of  note  that,  whatever  the  beneficial  result,  the  physiologic 
action  of  the  nitrites  is  chiefly  depressant  to  the  ^'asoconst^icto^  muscle 
tissue  in  the  arterioles. 
15 


226  STIMULANTS  AND  TONICS 

TONICS. 

Tonics  are  frequently  defined  as  permanent  stimulants.  This  conveys 
the  idea  of  permanency  of  result  which  always  pertains  to  the  class,  but 
we  must  note  that  tonics  may  not  have  any  proper  stimulating  action. 
It  is  difficult  to  form  a  definition  that  will  include  all  remedies  of  the 
class,  because  of  the  wide  dift'erence  in  their  nature  and  action.  Their 
chief  value  is  in  relation  to  the  reserve  energy  of  organs,  which  they 
conserve  by  supplying  the  necessary  materials  for  tissue  renovation  and 
for  the  production  of  energy,  or  by  otherwise  promoting  nutrition.  Iron 
is  classed  as  a  restorative  tonic  for  the  reason  that  it  supplies  a  normal 
constituent  to  the  blood  and  tissues.  The  ordinary  foods  hold  a  similar 
place  and  must  be  regarded  as  tonics  in  the  sense  that  they  restore 
needed  material.  On  the  other  hand,  bathing  and  massage  will  promote 
the  general  nutrition  of  the  body,  and  are,  therefore,  tonic  remedies. 
The  simple  bitters,  such  as  gentian,  taken  into  the  stomach,  stimulate 
the  digestive  functions  and  thus  indirectly  promote  general  nutrition, 

A  simple  classification  which  will  aid  our  study  of  these  substances, 
may  be  made  as  follows: 

Nutritional  Tonics — those  that  promote  the  general  processes  of 
nutrition. 

Examples. — Bitter  tonics,  bathing,  and  massage. 

Restorative  Tonics — those  that  supply  material  for  tissue  reconstruc- 
tion or  energy  production. 

Examples.^ — Iron,  foods,  and  phosphorus. 

Nutritional  Tonics. 

Among  the  class  of  nutritional  tonics — i.  e.,  those  that  promote  the 
general  processes  of  nutrition^ — are  those  that  act  by  increasing  the 
activity  of  digestion.  These  are  known  as  stomachic  tonics  or  simple 
bitters.  Their  chief  characteristic  is  their  bitterness,  by  which  they 
seem  to  stimulate,  possibly  through  primary  irritation,  the  mucous 
membrane  and  secretory  glands  of  the  stomach.  The  immediate  result 
of  their  presence  in  the  stomach  is  to  retard  or  lessen  secretion,  but  this 
is  soon  succeeded  by  an  increase  of  secretion,  so  that  the  full  eftect, 
obtained  fifteen  to  thirty  minutes  after  administration,  is  an  increase  of 
gastric  juice  and  of  motility  of  the  stomach.  They  should  be  given 
before  meals  so  that  their  full  action  may  be  secured  in  time  for  the 
beginning  of  stomach  digestion.  The  chief  agents  of  this  character  are 
here  given.     (For  preparations  and  doses,  see  Index  of  Drugs.) 


TONICS  227 

Simyle  Bitters. 

Calumba. — Columbo. — ^The  root  of  Jateorrhiza  palmata. 

Gentiana. — Gentian. — ^The  root  of  Gentiana  lutea. 

Quassia. — ^The  wood  of  Picrasma  excelsa  or  of  Quassia  amara. 

Of  any  of  these  the  tincture  (in  case  of  gentian  the  compound  tincture) 
is  a  leading  preparation  and  may  be  given,  in  case  of  each,  in  a  dose  of 
f5  l-l  (1-4  mils).  The  infusion  of  quassia  is  easily  prepared  with  cold 
water,  and  may  be  given  freely. 

To  this  group  of  simple  bitters  must  be  added  several  other  drugs  that 
are  equally  efficient  as  stomachics,  but  whose  more  important  action 
gives  them  a  larger  place.    They  are  sometimes  called: 

Peculiar  Bitters. 

Cinchona. — Peruvian  Bark. — ^The  bark  of  a  number  of  species  of 
cinchona.  It  contains  quinine  and  many  other  alkaloids.  (For  prep- 
arations and  doses,  see  Index  of  Drugs.)  Quinine  represents  the  drug 
fully.    (For  its  combinations  and  doses,  see  Index  of  Drugs.) 

Besides  being  a  bitter  tonic,  quinine  is  an  efficient  antiseptic,  but  its 
bitterness  prevents  its  extensive  internal  use  as  such;  although  it  is  some- 
times employed  as  an  intestinal  antiseptic,  given  by  stomach  or  injected 
into  the  colon.  Its  most  valuable  and  distinctive  use  is  in  malarial  fever 
(fever  and  ague),  in  which  disease  it  is  a  specific,  preventing  in  the  blood 
the  growth  of  the  plasmodium  malarise,  upon  which  the  disease  depends. 
This  must  be  regarded  as  a  true  antiseptic  action,  obtained  after  absorp- 
tion of  the  drug,  which  for  this  purpose  is  given  in  full  dose  of  15  to  30 
grains  (1-2  gm.)  daily,  in  single  or  divided  doses.  A  favorite  method  is 
to  give  15  grains  (1  gm.)  in  one  dose  daily,  about  three  hours  before  the 
expected  paroxysm.  The  average  tonic  dose  of  a  quinine  salt  is  gr.  1| 
(0.1  gm.),  before  each  meal. 

A  form  of  supra-orbital  neuralgia  supposed  to  be  of  malarial  origin, 
known  as  hroiv  ague,  which  presents  the  periodic  character  of  malarial 
fever,  in  that  it  occurs  at  about  the  same  hour  each  day,  or  every  second 
day,  continues  with  severity  for  some  hours  and  then  disappears,  is 
promptly  relieved  by  a  full  dose  of  quinine  daily,  three  hours  before  the 
usual  time  of  its  onset. 

Quinine  sulphate  is  the  salt  mostly  employed,  but  it  is  only  slightly 
soluble  in  water,  except  when  an  acid  is  added.  The  bisulphate  is  freely 
soluble.  With  the  giving  of  large  doses  of  quinine  there  occur  the 
evidences  of  saturation,  that  are  known  as  cinchonism.  Ringing  in  the 
ears  and  fulness  of  the  head  are  the  symptoms  of  this  condition,  which 
is  not  serious,  but  passes  away  soon  after  cessation  of  the  drug.    Quinine 


228  STIMULANTS  AND   TONICS 

is  used  much  less  now  than  it  was  in  former  years,  before  its  precise 
action  and  its  hmitations  were  understood. 

Nux  Vomica. — The  seeds  of  Strychnos  Nux-vomica,  containing  not  less 
than  2.25  per  cent,  of  alkaloids.  (For  preparations  and  doses,  see 
Index  of  Drugs.)  The  chief  alkaloid,  strychnine,  has  been  fully  considered 
as  a  stimulant.  It  is  valuable  also  as  a  bitter  tonic,  as  are  the  prepara- 
tions of  nux  vomica.  All  preparations  are  intensely  and  persistently 
bitter.  The  special  value  of  this  drug,  in  its  general  tonic  use,  lies  in  the 
fact  that,  after  its  local  effect  in  the  stomach,  its  absorption  is  followed 
by  a  general  increase  in  the  activity  of  all  reflexes,  through  its  action 
upon  ner^•e  centers  of  reflex  action.  This  is  the  effect  that  pertains  to 
the  action  of  the  alkaloid  strychnine  in  its  use  as  a  stimulant.  The  tinc- 
ture of  nux  vomica  is  the  preparation  most  commonly  used  as  a  bitter 
tonic.  In  large  doses  the  drug  is  poisonous,  causing  very  characteristic 
tonic  convulsions  which  affect  chiefly  the  muscles  whose  nerve  supply 
is  directly  from  the  spinal  cord.    (See  Table  of  Poisons  and  Antidotes.) 

Prunus  Virginiana. — Wild  Cherry. — The  bark  of  Pntnus  serotina, 
gathered  in  the  autumn.  (For  preparations  and  doses,  see  Index  of 
Drugs.)  In  addition  to  its  action  as  a  stomachic  tonic,  this  drug  pos- 
sesses decided  sedative  properties,  which  are  due  to  the  presence  of 
hydrocyanic  acid  in  its  preparations.  This  substance  does  not  exist  in 
the  crude  drug,  but  is  developed  when  the  latter  is  treated  with  cold 
water.  By  a  reaction  between  two  constituents,  amygdalin  and  emuhm, 
a  volatile  oil  identical  with  oil  of  bitter  almond  is  formed.  This  contains 
hydrocyanic  acid.  Wild  cherry  finds  its  special  use  where  a  general  or 
local  ner^'e  sedative  is  indicated,  in  connection  with  a  stomachic  tonic. 
In  cough  mixtures  its  preparations  fill  a  useful  place.  Its  local  sedative 
and  tonic  effects  make  it  a  remedy  that  is  applicable  in  irritable  con- 
ditions of  the  stomach,  to  control  vomiting  and  improve  digestion. 

Restorative  Tonics. 

This  class  comprises  both  the  ordinary  food  substances,  that  supply 
material  for  tissue  reconstruction  and  energy  production,  and  the 
medicinal  agents  that  are  really  foods  in  the  sense  that  they  are  neces- 
sary to  the  tissues. 

Passing  the  ordinary  food  substances  with  the  simple  mention  of 
oxygen,  water,  starchy,  fatty  and  nitrogenous  foods  and  sodium  chloride, 
our  chief  consideration  will  be  gi^'en  to  the  restoratives  ordinarily 
regarded  as  me(ficines.  Inasmuch  as  they  aid  chiefly  by  restoring  some 
element  that  is  lacking,  their  precise  action  requires  no   extended  dis- 


TONICS  229 

cussion.  We  are  more  concerned  with  the  form  or  combination  of  the 
drug  in  order  to  pleasant  administration  and  ready  assimilation. 

Ferrum. — Iron  [Fe]. — (For  preparations,  their  reactions  and  doses, 
see  Index  of  Drugs.)  This  metal  is  commonly  employed  either  in  its 
pure  form  of  reduced  iron  or  in  one  of  its  many  combinations.  The 
large  number  of  these  supply  every  need  of  form,  and  of  adaptability  to 
the  various  conditions  that  call  for  its  use.  Those  most  frequently  used 
are  ferrum  reductum,  massa  ferri  carbonatis,  ferri  pjTophosphas, 
tinctura  ferri  chloridi,  and  s}Tupus  ferri  iodidi.  The  last-named  is 
alterative  as  well  as  restorative,  and  a  most  useful  agent  in  the  treatment 
of  so-called  scrofulous  conditions  in  children. 

Besides  these  preparations  the  great  variety  of  compound  salts  find 
special  uses.  Ferri  hydroxidum,  or  ferric  hydrate,  is  the  most  useful 
chemical  antidote  to  arsenic.  The  real  systemic  action  of  iron  is  mainly 
in  the  blood,  and,  whatever  salt  or  combination  is  employed,  the  iron 
is  believed  to  be  changed  to  the  chloride  before  absorption.  It  furnishes 
material  for  the  coloring  matter  of  the  red  cells,  therefore  it  is  especially 
indicated  where  there  is  deficiency  of  hemoglobin  (chlorosis). 

It  should  be  insisted  upon  that  it  is  unnecessary  to  use  the  new  and 
largely  advertised  preparations  of  iron.  As  a  rule  they  are  expensive, 
and  they  are  not  at  all  superior  to  the  older,  well-known,  official  forms. 
The  reaction  of  iron  salts  should  be  noticed,  and  for  prolonged  use  those 
that  are  neutral  selected  by  preference,  so  as  to  avoid  damage  to  the 
teeth.  Only  those  that  have  an  acid  reaction  can  affect  the  tooth  struc- 
ture, but  staining  may  follow  the  use  of  any  preparation  in  a  mouth 
that  is  not  kept  scrupulously  clean.  This  stain,  which  is  usually  sulphide 
of  iron,  may  be  easily  removed  from  the  surface  of  the  enamel,  but  in  a 
cavity  it  may  be  more  permanent.  The  tinctm'e  of  the  chloride  is  one 
of  the  strongly  acid  preparations  that  must  be  used  with  care.  Its 
contact  with  the  teeth  may  be  limited  by  taking  it  through  a  glass  tube, 
but  a  more  positive  safeguard  is  to  ensure  neutralization  of  the  acid  by 
rinsing  the  mouth,  before  and  after  taking,  with  a  solution  of  sodium 
bicarbonate  or  other  alkali. 

Mineral  Acids. — These  are  used  internally  only  in  the  dilute  form. 
Even  then  they  should  be  further  diluted,  and  the  same  precautions 
taken  to  protect  the  teeth  as  are  mentioned  above. 

Acidum  Hydrochloricum  Dilutum. — ^Diluted  Hydrochloric  Acid. — 
10  per  cent,  by  weight  of  absolute  hydrochloric  acid. 

Acidum  Nitricum  Dilutum. — Diluted  Nitric  Acid. — 10  per  cent,  b}^ 
weight  of  absolute  nitric  acid  (not  official). 


230  STIMULANTS  AND   TONICS 

Acidum  Nitrohydrochloricum  Dilutum. — Diluted  Nitrohydrochloric 
Acid. — 4  per  cent,  nitric  acid  and  18.2  per  cent,  hydrochloric  acid. 

Acidum  Sulphuricum  Dilutum. — Diluted  Sulphuric  Acid. — 10  per 
cent,  by  weight  of  absohite  sulphuric  acid. 

Acidum  Sulphuricum  Aromaticum. — ^Aromatic  Sulphuric  Acid. — 
20  per  cent,  by  weight  (or  about  10  per  cent,  by  volume)  of  absolute 
sulphuric  acid  in  nearly  pure  alcohol. 

The  average  dose  of  either  of  these  isTTl  15  (1  mil).  They  are  given 
after  meals,  as  a  rule.  A  very  important  use  of  dilute  hydrochloric  acid 
is  to  restore  the  quality  of  the  gastric  juice  when  its  acid  is  deficient.  It 
being  the  normal  acid  of  this  digestive  fluid,  its  administration  furnishes 
one  of  the  most  typical  instances  of  restorative  treatment. 

Vegetable  Acids. — These  include: 

Acidum  Citricum. — Citric  Acid. 

Acidum  Tartaricum. — Tartaric  Acid. 

It  is  not  easy  to  explain  the  action  of  vegetable  acids  upon  the  ground 
of  supplying  normal  elements  that  are  lacking  in  the  system.  But  their 
use  is  established  by  long  clinical  experience  in  certain  conditions  of 
disturbed  nutrition  that  follow  prolonged  abstinence  from  fresh  foods, 
as  with  sailors  upon  long  sea  voyages.  The  disease  induced  is  known 
as  scurvy,  and  it  seems  to  present  an  altered  or  depraved  condition  of 
the  blood  as  its  chief  pathology.  Upon  the  skin  and  mucous  membranes 
more  or  less  extensive  spots  of  ecch\Tnosis  occur,  the  particular  kind  of 
lesion  being  known  as  purpura.  The  abnormal  condition  of  blood  is 
usually  promptly  removed,  with  full  return  of  health,  by  a  free  supply 
of  fresh  fruits,  vegetables,  and  meats.  Citric  acid,  alone  or  as  present 
in  the  juice  of  lemons  or  limes,  is  a  valuable  addition  to  the  dietetic 
treatment  of  scurvy.  Orange-juice  is  likewise  added  to  the  diet  of  infants 
fed  upon  sterilized  or  pasteurized  milk.  Tartaric  acid  is  used  simply 
as  a  substitute  for  citric  acid. 

Phosphorus  [P]. — (For  preparations  and  doses,  see  Index  of  Drugs.) 
This  substance  is  of  the  greatest  importance  to  the  system,  in  its 
capacity  as  a  restorative.  Among  other  effects  of  its  prolonged  use,  it 
has  been  shown  to  have  the  power  of  inducing  more  rapid  growth  of 
bone,  as  was  found  to  result  in  experiments  upon  animals.*  Accordingly, 
it  may  be  of  service  in  delayed  dentition  and  in  rachitis;  but,  owing  to 
the  very  disagreeable  taste  of  pure  phosphorus,  we  usually  have  to  be 
content  with  the  use  of  phosphates,  hypophosphites  and  dilute  phos- 

*  Therapeutics,  H.  C.  Wood,  eleventh  edition,  pp.  431-32. 


TONICS  231 

phoric  acid.  The  most  common  form  of  pure  phosphorus  for  admin- 
istration is  the  official  pill  containing  ^qq  of  a  grain  (0.0006  gm.).  It  is 
particularly  indicated  in  certain  diseases  of  the  nervous  system  and  in 
conditions  of  deficient  bone  nutrition. 

(For  poisoning  by  phosphorus,  see  Table  of  Poisons  and  Antidotes.) 

Acidum  Phosphoricum  Dilutum. — Diluted  Phosphoric  Acid. — 10  per 
cent.  This  acid  is  used  as  a  general  nerve  tonic  and  substitute  for 
phosphorus.     Average  doselU  30  (2  mils). 

Sjrrupus  Hypophosphitum. — Syrup  of  Hypophosphites. — (Incom- 
patible with  tincture  of  chloride  of  iron.)     Average  dose  f5  2|  (10  mils). 

Syrupus  Hypophosphitum  Compositus. — Compound  Syrup  of  Hypo- 
phosphites  (not  official).     Average  dose,  f5   1  (4  mils). 

Syrupus  Ferri,  Quininse  et  Strychninse  Phosphatum. — Syrup  of  the 
Phosphates  op  Iron,  Quinine  antd  Strychnine  (not  official).  Dose 
f5  i-1  (2-4  mils). 

The  hypophosphites  are  useful,  both  as  substitutes  for  phosphorus 
and  as  furnishing  combinations  of  the  drug  that  may  be  more  easily 
appropriated  by  the  system.  They  are  certainly  less  unpleasant  to  take. 
They  are  largely  used  in  rachitis,  in  wasting  diseases  such  as  tuberculosis, 
and  in  diseases  of  the  blood  and  of  the  nervous  system. 

Oleum  Morrhuse. — Cod-liver  Oil. — A  fixed  oil  expressed  from  the 
fresh  livers  of  Gadus  morrhua  and  other  species  of  Gadus.  Average 
dose,  f5  21  (10  mils). 

It  is  produced  mostly  upon  the  coasts  of  Norway,  Newfoundland  and 
Massachusetts. 

Its  value  is  that  of  a  fatty  food  which  also  contains  traces  of  iodine, 
chlorine,  bromine,  phosphorus  and  sulphur.  These  contribute  a  slightly 
alterative  property  to  the  oil.  It  is  used  in  wasting  diseases,  especially 
in  tuberculosis,  and  in  poorly  noiu'ished  children.  The  so-called 
scrofulous  conditions  are  benefited  by  it.  The  taste  of  the  oil  is  dis- 
agreeable to  many,  so  it  is  used  largely  in  the  form  of  emulsion.  The 
pure  oil  is  sometimes  used  by  inunction  when  stomach  administration 
is  impracticable.  If  taken  about  two  hours  after  meals  much  of  the 
unpleasantness  in  the  way  of  eructations  will  be  avoided.  Typical 
emulsions  are  the  following: 

Emulsum  Olei  Morrhuae. — Emulsion  of  Cod-liver  Oil. — 50  per  cent. 
Average  dose,  f5  4  (15  mils). 

Emulsum  Olei  Morrhuse  cum  Hypophosphitibus. — Emulsion  of  Cod- 
liver  Oil  with  Hypophosphites. — ^This  contains  50  per  cent,  oil, 
with  hypophosphites  of  calcium,  potassium  and  sodium  (not  official). 
Average  dose,  f5  4  (15  mils). 


CHAPTER  XVI. 
ALTERATIVES. 

Alteratives  have  been  defined  as  agents  that  counteract  morbid 
states  of  tissues  by  altering  the  processes  of  nutrition  in  a  favorable 
manner.  They  seem  to  have  little  direct  influence  upon  irritability  or 
functional  activity  of  cells.  Alteratives  become  a  part  of  the  cell  contents 
for  the  time  that  they  remain  in  the  system,  and  some  of  the  metallic 
alteratives  become  so  fixed  that  they  may  be  detected  for  weeks  in  the 
tissues.  Their  action  is  slow  and  their  effects  permanent,  as  might  be 
expected  of  agents  that  enter  so  intimately  into  the  composition  of  the 
cells.  The  typical  conditions  that  call  for  their  use  are  those  that  are 
brought  about  by  the  damaging  influence  of  bacteria  or  toxic  chemical 
bodies,  that  alter  the  nutrition  of  the  cells.  Syphilis  stands  as  the  dis- 
ease that  probably  most  purely  presents  the  indications  for  the  use  of 
alteratives.  Altered  states  of  the  blood  and  of  organs  likewise  call  for 
their  use. 

The  precise  mode  of  action  of  alteratives  is  obscure,  their  effects 
appearing  without  any  evident  changes  of  organic  functions,  except  that 
of  gradual  improvement. 

Arseni  Trioxidum. — i\.RSENic. — Arsenons  Acid  [AS2O3]. — The  value  of 
arsenic  internally  is  mostly  as  a  blood  alterative,  in  those  forms  of 
anemia  where  the  red  cells  are  abnormal.  It  is  also  useful  in  certain 
nervous  diseases,  particularly  in  chorea  (St.  Vitus'  dance),  and  in  some 
chronic  diseases  of  the  skin. 

Liquor  Acidi  Arsenosi. — Solution  of  Arsenous  Acid. — 1  per  cent. 

Liquor  Potassii  Arsenitis. — Fowler's  Solution. — Strength  corresponds 
to  1  i)er  cent,  of  arsenic  trioxide. 

Liquor  Sodii  Arsenatis. — 1  per  cent. 

These  three  solutions  are  uniform  in  strength  and  have  the  same 
average  dose,  TTl  3  (0.2  mil).  The  first  is  arid  in  reaction,  while  the 
second  and  third  are  (dixalinc. 

Liquor  Arseni  et  Hydrargyri  lodidi. — Donovan's  Solution. — 1  per  cent, 
each  of  arsenous  iodide  and  mercuric  iodide.  Average  dose,  Ttl  1|  (0.1 
mil). 

The  pure  arsenic  trioxide  and  Fowler's  solution  are  the  forms  most 


ALTERATIVES  233 

commonly  employed.  Beginning  with  small  or  moderate  doses,  they 
may  be  increased  to  the  limit  of  toleration,  which  is  shown  by  irritability 
of  the  stomach  and  puffiness  about  the  eyelids. 

Donovan's  solution  is  a  more  powerful  general  alterative,  as  it  com- 
bines arsenic,  mercury  and  iodine. 

Hydrargyrum, — Mercury. — Quicksilver  [Hg]. — (For  fuller  list  of 
preparations  and  doses,  see  Index  of  Drugs.)  Mercury  is  used  very 
largely  in  the  form  of  combinations,  but  there  are  several  preparations 
in  which  metallic  mercury  is  used,  reduced  to  a  very  finely  divided  con- 
dition.   Following  are  the  preparations  most  commonly  used: 

Hydrargyrum  cum  Creta. — Mercury  with  Chalk. — Contains  38  per 
cent,  by  weight,  of  metallic  mercury. 

Massa  Hydrargyri. — Blue  Mass. — Blue  Pill. — Contains  33  per  cent., 
by  weight,  of  metallic  mercury. 

Unguentum  Hydrargyri. — Blue  Ointment. — Contains  50  per  cent., 
by  weight,  of  metallic  mercury. 

Oleatum  Hydrargyri. — Oleate  of  Mercury. — Contains  25  per  cent., 
by  weight,  of  yellow  mercuric  oxide. 

Hydrargyri  Chloridum  Mite. — Mild  Mercurous  Chloride. — Calomel. 
Monochloride  of  Mercury.    Protochloride  of  Mercury  [HgCl]. 

Hydrargyri  Chloridum  Corrosivum. — Corrosive  Mercuric  Chloride. 
— Corrosive  Sublimate.     Bichloride  of  Mercury.     Perchloride  of  Mercury 

[Hgcy. 

Hydrargyri  lodidum  Flavum. — Yellow  Mercurous  Iodide. 

Hydrargyri  lodidum  Rubrum. — ^Red  Mercuric  Iodide. 

Hydrargyri  Salicylas. — Mercuric  Salicylate. — Mercuric  Subsalicy- 
late.— This  salt  is  used  largely  hypodermically  in  the  treatment  of 
s}^hilis.    Average  dose,  gr.  i  (0.06  gm.). 

The  t}^ical  use  of  mercury  as  an  alterative  is  in  the  treatment  of 
secondary  s;vT)hilis.  As  it  is  desirable  to  obtain  its  full  influence  as  soon 
as  possible,  the  ointment  or  the  oleate  may  be  rubbed  into  the  skin 
freely.  Aside  from  these,  the  non-cathartic  preparations  may  be  em- 
ployed internally.  Blue  mass  and  calomel  are  seldom  given  in  syphilis, 
but  are  ^^aluable  cathartic  agents. 

The  constitutional  symptoms  produced  by  mercury,  with  the  treat- 
ment of  the  same,  are  discussed  in  the  article  on  Antiseptics.  (See  also 
the  article  later  on  Syphilis  and  its  Treatment.) 

ledum. — Iodine  [I]. — This  substance  is  not  commonly  administered  in 
its  free  state  internally,  because  of  its  irritating  character.  It  is,  however, 
a  valuable  alterative,  and  may  be  taken  in  large  quantity  in  non-irritant 


234  ALTERATIVES 

combinations.  The  iodides,  which  contain  a  large  proportion  of  iodine, 
constitute  a  distinct  group  of  general  alterative  agents,  the  most  useful 
of  which  is  sodium  iodide. 

Sodii  lodidum  [Xal]. — Estimated  by  the  atomic  weights  of  its  com- 
ponents, this  salt  contains  about  85  per  cent,  of  iodine.  Being  much  less 
irritating  than  iodine,  it  furnishes  the  means  of  getting  a  large  amount 
of  the  latter  into  the  system  without  much  disturbance.  This  salt  is 
used  in  the  treatment  of  acute  asthma,  in  chronic  rheumatism  and  other 
conditions  of  tissue  alteration,  but  its  most  extensive  use  is  in  tertiary 
syphilis.  wSodium  iodide  possesses  advantages  over  potassium  iodide 
in  the  following  points:  It  contains  more  iodine.  It  is  slightly  more 
soluble.  It  is  less  irritating,  sodium  being  better  tolerated  by  the 
system  than  is  potassium.  (See  article  below  on  S\^hilis  and  its 
Treatment.) 

Potassii  lodidum  [KI]. — Potassium  iodide  has  about  70  per  cent,  of 
iodine  in  its  composition.  Its  uses  are  the  same  as  those  of  the  sodium 
salt. 

Other  iodides  are  useful  according  to  the  particular  combinations 
employed.  The  following  are  some  of  the  most  important  preparations 
in  frequent  use: 

Syrupus  Ferri  lodidi. — Syrup  of  Iodide  of  Iron. — This  is "  a  very 
valuable  preparation  for  use  in  the  so-called  "scrofulous"  conditions. 
It  may  be  taken  for  an  indefinite  period  by  children  who  show  the 
characteristic  enlargement  of  lymph  nodes. 

Arseni  lodidum  [AsIs]. — Arsenous  iodide  is  used  chiefly  in  Donovan's 
solution,  the  liquor  arseni  et  hydrarg^Ti  iodidi. 

Syphilis  and  its  Treatment. 

Syphilis  is  a  disease  that  is  contagious  and  infectious  in  nature, 
one  that  may  be  met  with  in  any  walk  of  life,  whether  acquired  inno- 
cently or  through  vicious  conduct.  It  may  be  inherited  in  certain  of 
its  forms.  It  is  a  disease,  moreover,  of  which  its  possessor  may  be  ignor- 
ant, both  as  to  its  character  and  the  source  of  infection,  since  the  lesion 
of  original  infection,  the  chancre,  may  occur  upon  various  parts  of  the 
surface  of  the  body,  where  infection  must  have  been  purely  accidental. 
The  importance  of  this  to  the  dentist  is  emphasized  by  the  further  fact, 
that  the  highly  infectious  secondary  lesions  are  prominent  in  the  mouth 
and  throat,  constituting  here  a  danger  to  the  dental  operator  directly, 
and  to  others  indirectly.     Syphilitic  lesions  are  commonly  painless, 


SYPHILIS  AND  ITS   TREATMENT  235 

which  adds  to  the  danger  of  non-recognition  of  the  superficial  mouth 
lesions. 

The  occasional  occurrence  of  a  chancre  upon  the  hand  of  a  dentist, 
justifies  the  advice  that  a  constant  lookout  for  the  presence  of  the  dis- 
ease, in  mouths  coming  under  examination,  should  be  exercised.  This 
implies  a  certain  degree  of  familiarity  with  the  symptoms  of  the  disease. 
Every  opportunit}',  therefore,  to  study  this  disease  should  be  improved, 
as  a  matter  of  personal  safety  and  of  duty  to  others.  The  dental  specialist 
certainly  owes  it  to  his  patients  and  to  himself,  to  supplement  his  dental 
college  course  by  a  post-graduate  study  of  syphilis  in  its  chief  clinical 
features.  Without  such  thorough  study  of  the  manifestations  of  the 
disease,  it  is  unsafe  to  attempt  to  diagnose  its  various  lesions  either  of 
the  mouth  or  skin,  for  the  liability  to  error  is  very  great ;  and  even  physi- 
cians of  experience  will  often  seek  expert  opinion  as  to  the  nature  of  a 
suspected  lesion. 

A  word  of  caution  is  here  appropriate.  It  may  fall  to  the  practitioner 
to  discover  a  case  of  s^■philis,  by  mouth  symptoms,  where  it  had  not 
been  suspected;  but  he  must  be  exceedingly  cautious  about  discussing 
this  finding  with  his  patient.  He  is  dealing  with  a  matter  for  which  he 
has  not  been  consulted,  and  in  any  suspicious  acts  or  words  of  his,  lie  the 
possibilities  of  much  unpleasantness.  If  the  patient  be  an  innocent  wife 
a  statement  of  his  discovery  might  produce  domestic  discord.  "While 
she  would  have  a  most  serious  grievance,  entitling  her  to  om*  pity,  a 
revelation  could  only  add  to  her  unhappiness.  A  suggestion  to  her  to 
see  ^er  family  physician  for  certain  general  conditions  that  you  find 
evidence  of,  would  be  the  proper  course;  and  even  this  advice  must  be 
given  tactfully,  without  arousing  suspicion  as  to  the  probabilities  in 
the  case,  for,  after  all,  a  mistaken  diagnosis  is  possible.  Any  other 
course  would  also  endanger  professional  relations  with  the  family 
physician. 

The  point  of  greatest  practical  importance  is,  to  be  so  careful  in  the 
manipulation  of  instruments  as  to  avoid  all  danger  of  self-infection;  for 
the  saliva  of  a  patient  with  secondary  mouth  symptoms  may  infect  any 
abrasion  of  the  skin  that  it  comes  in  contact  with.  As  a  matter  of  course, 
all  instruments  and  appliances  used  will  be  thoroughly  sterilized  imme- 
diately after  the  operation. 

As  a  basis  for  study,  a  scheme  is  herewith  given,  which  mcludes  stages 
of  the  disease  with  their  characteristic  sjTiiptoms,  and  the  application  of 
remedies  appropriate  to  each: 


236 


ALTERATIVES 


.Syphilis,  its  Stages,  Symptoms  and  Treatment. 

Stages.  Symptoms. 

The  chancre,  located  usually  upon  the  geni- 
tals, but  may  occiu-  upon  any  mucoas  or 
cutaneous  surface. 

Enlargement  of  lymph  nodes  in  all  parts 
of  the  body,  but  not  distinctive  of  this 
disease. 


Primary  symptoms 
appear  about  three 
weeks    after   infec- 
tions.   The  lesion  is 
very  infectious. 


Secondary  symptoms 
occur  about  six  or 
eight  weeks  after 
infection,  unless 
earUer  treatment 
has  arrested  the  dis- 
ease. The  lesions  in 
the  mouth  (mucous 
patches)  are  exceed- 
iitgly  infectious. 


Tertiary  symptoms 
may  be  prevented 
by  treatment.  In 
cases  not  treated 
the  tertiary  symp- 
toms occur  in  from 
one-half  to  two 
years  after  infec- 
tion, but  they  may 
be  delayed.  The 
lesions  are  only 
slightly  infectious. 


A  superficial  rash,  sUght  or  abundant,  dis- 
tributed upon  all  regions  of  the  body. 

Sore-throat. 

Mucous  patches  anywhere  upon  mucous 
membrane  of  mouth  or  throat,  usually 
u])on  inner  surface  of  cheeks  or  under 
tongue. 

Loss  of  hair,  shght  or  marked. 


Deeper  lesions  of  the  skin,  eithei"  single  or 
multiple,  but  not  of  general  distribution. 

Periosteal  pains,  chiefly  in  head  and  long 
bones,  occurring  mostly  at  night. 

Gumma,  occurring  mostly  upon  skin,  in  the 
nervous  system,  or  smaller  bloodvessels, 
but  occasionally  in  any  part  of  the  system. 

Deep  ulcers  of  the  skin  sometimes  resulting 
from  the  breaking  down^  of  gummata. 
Usualh^  single,  or,  if  double,  located  upon 
symmetrical  portions  of  body. 

Degenerations  of  circulatory  or  nervous 
systems.  The  arteries,  brain  and  spinal 
cord  are  usual  sites  of  degeneration. 


Medicinal 
treatment. 


>  -,  Salvarsan. 


Mercury. 


Sodium. 
iocUde. 


The  discovery  of  the  spirocheta  pallida,  beHe^'ed  to  be  the  cause  of 
syphiHs,  has  rendered  possible  an  early  diagnosis  in  the  primary  stage, 
which  permits  the  beginning  of  treatment  at  once,  instead  of  waiting 
until  the  appearance  of  secondary  s;^Tnptoms  confirms  the  clinical 
diagnosis,  as  was  formerly  the  common  practice.  The  introduction  of 
salvarsan  also  has  marked  an  advance  in  the  efficiency  of  treatment, 
whereby  the  disease  may  be  arrested  early  and  a  cure  effected  without 
the  occurrence  of  secondary  symptoms. 

Outline  of  Treatment. — When  a  case  is  seen  soon  after  the  appearance 
of  the  chancre,  the  diagnosis  should  be  made  positive  by  the  dark-field 
examination  of  scrapings  or  serum  from  the  lesion.  If  this  reveals  the 
spirochete,  treatment  with  .salvarsan  should  begin  at  once.  This  drug  is 
administered  intravenously  in  normal  salt  solution;  8  to  12  injections 
are  gi\'en,  at  first  weekly  for  five  or  six  weeks,  then  at  intervals  of  a 
month  or  more.  In  addition  to  this,  a  course  of  mercury  is  begun  early 
and  both  remedies  are  continued  during  the  first  year.  The  preparations 
of  mercury  now  most  commonly  employed  are  the  oO  per  cent,  ointment, 


SYPHILIS  AXD  ITS    TREATMEXT  237 

by  inunction,  pushed  to  the  point  of  saturation,  or  salicylate  of  mercury 
gr.  1  (0.06  gm.)  given  each  week  by  deep  intramuscular  injection.  Other 
preparations  may  be  employed,  some  using  the  bichloride  h\-podermi- 
cally  while  others  prefer  the  yellow  iodide  by  mouth.  Diu-ing  the  second 
year  the  same  remedies  may  be  continued  at  intervals,  or  treatment 
may  depend  upon  the  results  of  Wassermann  blood  tests  made  every 
two  or  three  months.  In  case  the  s\Tnptoms  do  not  yield  readily,  and 
particularly  in  the  tertiary  stage,  an  iodide  by  mouth  (preferably  soditun 
iodide)  may  be  added  to  the  treatment.* 

The  question  whether  s^-philis  may  be  cured  has  been  regarded  as  a 
debatable  one,  but  it  is  one  which  now  admits  of  an  affirmative  answer. 
The  fact  remains,  however,  that  very  many  cases  are  not  permanently 
cured.  AVhen  we  appreciate  that  a  cm-e  means  the  taking  of  medicines 
almost  continuously  for  two  years,  and  that  syphilis  is  a  disease  whose 
SATnptoms  yield  very  promptly  to  treatment,  it  caimot  be  expected  that 
more  than  a  small  percentage  of  patients  will  continue  treatment  for 
the  necessary  length  of  time  after  they  feel  perfectly  well. 

A  positive  ctu-e  would  mean  a  total  of  three  years'  observation,  the 
first  two  with  active  treatment,  and  the  absence  of  all  symptoms  with 
negative  Wassermann  tests  thi'ough  the  third  year.  ^Marriage  cannot 
be  properly  entered  into  without  this  thorough  treatment  and  the  three 
years  of  observation. 

The  following  additional  drugs  are  simply  mentioned  as  representative 
of  the  class  of  vegetable  alteratives: 

Colchicum. — (For  preparations,  doses  and  uses,  see  Index  of  Drugs.) 
Guaiacum. — (For  preparations,  doses  and  uses,  see  Index  of  Drugs.) 
Sarsaparilla. — (For  preparations,  doses  and  uses,  see  Index  of  Drugs.) 
Sarsaparilla  must  be  regarded  as  the  least  valuable  of  this  group. 
In  fact,  its  value  is  so  slight  that  it  is  seldom  used  alone.     The  pro- 
prietary   "sarsaparilla    tonics"    all    contain    stronger    agents,    usually 
cathartic  in  action. 

*  The  continued  use  of  any  iodide  commonly  produces  a  rash,  consisting  of  pimples 
upon  the  face  and  elsewhere,  which  is  beUeved  to  be  nature's  efforts  to  eliminate 
iodine.    This  is  the  chief  sjTnptom  of  iodism,  or  saturation  with  the  drug. 


CHAPTER  XVII. 
SEDATIVES. 

A  SEDATR'E  is  defined  to  be  an  agent  that  diminishes  the  activity  of 
an  organic  function  or  process,  the  term  depressant  being  equally 
applicable.  All  sedatives  may  be  poisonous  when  given  in  large  dose; 
and  the  toxic  s\iTiptoms  usually  include  narcosis.  The  division  of  the 
large  list  of  sedative  agents  into  groups  designated  by  the  terms  arterial, 
nervous,  etc.,  is  a  convenience,  and  helps  to  fix  their  characteristic 
action,  but  no  distinct  lines  can  be  drawn  between  the  groups.  The 
terms  point  rather  to  the  most  prominent  features  of  their  action.  (See 
classification,  page  37.)  In  a  practical  sense  the  term  applies  to  effect 
but  not  always  to  action.  Stimulation  of  inhibition  may  produce  a 
slowing  or  restraining  effect,  which  we  may  call  depression  induced 
indirectly  by  stimulation.  Instances  of  this  kind  are  well  illustrated  in 
the  action  of  aconite,  as  Plate  XIV  shows.  Most  sedatives,  however, 
produce  their  effects  by  a  direct  depressant  action  upon  either  nerve  or 
muscle  tissue. 

As  a  rule,  children  bear  the  moderate  action  of  sedatives  very  well. 
The  nervous  system  during  childhood  is  so  sensitive  and  responsive, 
that  disturbed  function  in  most  cases  calls  for  depressant  rather  than 
stimulant  treatment. 

Cold  must  be  given  a  prominent  place  among  the  arterial  sedatives. 
Just  as  the  application  of  heat  acts  as  a  general  stimulant,  so  the  appli- 
cation of  cold  produces  the  opposite  effect.  Hyperemias  and  acute 
inflammations,  whether  in  and  about  a  tooth  or  elsewhere,  injuries 
to  tissues  leading  to  extravasation  of  blood,  cardiac  and  cerebral  excite- 
ment, all  may  be  greatly  relieved  by  the  application  of  cold.  In  this 
class  of  conditions,  however,  the  rule  should  be  recognized  of  employing 
either  cold  or  heat  according  to  which  affords  the  most  relief.  Methods 
of  applying  cold  are :  the  full  or  partial  cold  bath,  the  Leiter  coil  through 
which  ice-water  is  allowed  to  run,  the  ice-bag,  and  the  application  of 
liquids  that  evaporate  rapidly.  The  employment  of  freezing  methods 
belongs  to  another  chapter. 

Depletion  of  the  Circulation,  whether  by  bloodletting,  sweating  or 
active  catharsis,  is  another  means  of  reducing  circulatory  activity,  in 


PLATE    XIV. 


ACONITE. 

The  tuber  of  A.  Xapellus. 

The  alkaloid  Aconitiue  repre- 
sents the  drug  fully,  but  is 
the  most  poisonous  substance 
of  its  class.  Therefore  it  is 
seldom  used  internally. 


Sensory 
nerve  ending. 


Skin 
Classified  as : 

Arterial  depressant.     ,  , 

'-  depressed 

Cardiac  depressant. 

Kerve  depressant. 

Antipyretic. 

Physiologic  action  : 

Nervous  System. 

Brain.     No  influence  ni^on  cerebrum. 
Medulla.      Stimulates  vagus   center. 

depresses  respiratory  center. 
Spinal  cord.     Influence  imcertain. 
Sensory  nerve  endings  are  depressed  after  a  period  of 

slight  stimulation.  / 1 

Muscular  System.     Causes  general  muscular  weakness. 

Circulation.  Lessens  force,  rapidity  and  pressure  of  the  arterial 
current. 

Heart.  A  direct  influence  upon  the  heart  is  uncertain,  but 
by  stimulation  of  inhibition  the  heart  is  slowed  and  its  force 
weakened— the  result  being  cardiac  depression.  (Accord- 
ing to  some  authorities,  the  drug  depresses  the  heart  muscle 
and  its  motor  ganglia.) 

Capillary  area.  The  vasomotor  mechanism  is  not  influ- 
enced by  the  drug  in  therapeutic  doses. 

Temperature  is  reduced. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Symxjathetic 


The  red  color  indicates  the  stimulant  action 
of  Aconite  upon  the  vagus  center,  which 
causes  slowing  of  the  heart's  action.  The 
blue  color  indicates  the  depressant  effect 
of  the  drug. 


PLATE    XV. 


SODIUM  BROMIDE. 

[NaBr] 

[This  drug  is  regarded  as  the 
typical  and  most  important 
agent  of  the  group  of  bro- 
mides.] 

Classified,  as  : 

Cerebral  depressant. 
Nerve  depressant. 
Antispasmodic. 
Anaphrodisiac. 


iSkin 


Physiologic  action: 

Nervous  Systeni. 

Brain.  Depresses  the  cerebral  cortex,  and  espe- 
cially the  motor  areas. 

Medulla.     Not  affected  by  therapeutic  doses. 

Spinal  cord.  Lessens  reflex  irritability,  probably 
mainly  through  a  depression  of  the  sensory  por- 
tion of  the  cord. 

Sensory  nerve  endings  are  not  directly  affected,  any  less- 
ening of  sensation  being  due  to  central  action. 
Sexual  function  is  depressed. 
Circulation.     Arterial  pressure  is  lowered  somewhat. 
Heart.     Large  doses  depress  the  heart  slightlj^ 
Capillary  area.     Full  doses  cause  vasomotor  relaxation. 
Elimination.     The  drug  is  absorbed  rapidly  from  the  stomach  and 
intestines,  but  is  eliminated  slowly.     It  may  be  found  in  the 
several  excretions,  but  chiefly  in  the  urine. 

Other  bromides  have  essentially  the  same  action  as  sodium  bromide, 
but  the  latter  possesses  a  high  efiiciency  and  is  comparatively  non- 
irritating. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


The  blue  color  indicates  the  sedative 
effects  of  the  Bromides,  their  action 
upon  the  nervous  system  being 
much  more  important  than  that 
upon  the  circulation. 


BROMIDES  239 

addition  to  which  effect  these  measures  also  reduce  toxemia,  when  that 
is  a  factor. 

Of  the  medicinal  agents  the  most  typical  ones  of  the  several  groups 
are  here  presented. 

Aconitum.     (Plate  XIV.) 

This  drug  is  used  in  fevers  and  inflammations,  to  reduce  arterial  pres- 
sure. The  tincture  is  used  internally,  either  5  to  15  minims  (0.30-1  mil) 
several  times  daily,  or  in  two-drop  doses  hourly  until  the  effect  is  secured. 
With  an  equal  part  of  tincture  of  iodine,  the  tincture  is  used  as  an 
application  in  pericementitis  and  pulpitis.  The  alkaloid  aconitine  is 
applied  locally  in  form  of  the  oleate  in  the  treatment  of  neuralgias,  and 
in  obstinate  cases  it  may  be  given  internally  in  doses  of  gr.  ^q-q  (0.00015 
gm.). 

Veratrum  Viride  and  Veratrine  have  an  action  which  resembles  closely 
that  of  aconite. 

(For  preparations  and  doses,  see  Index  of  Drugs). 

The  uses  of  these  are  very  similar  to  those  of  aconite.  In  addition 
veratrum  viride  is  used  to  reduce  arterial  pressure  in  puerperal  con- 
vulsions. ' 

Acidum  Hydrocyanicum  Dilutum. — (See  Index  of  Drugs.) 

The  preparations  of  wild  cherry  {Prunus  virginiana)  owe  their 
sedative  value  to  the  presence  of  a  small  quantity  of  hydrocyanic  acid. 
These  are  useful  as  excipients  in  cough  mixtures;  but  when  a  decided 
effect  from  definite  dosage  is  desired,  the  dilute  hydrocyanic  acid  (2  per 
cent.)  is  used  in  doses  of  1  to  2  minims  (0.06-0.12  mil).  The  strong 
hydrocyanic  or  prussic  acid  is  never  used,  as  it  is  too  poisonous  even 
to  manufacture. 

Bromides.     (Plate  XV.) 

Sodii  Bromidum. — Sodium  Bromide  [NaBr].^ — The  sodium  salt  repre- 
sents the  group  well,  and  is  entitled  to  preference  over  the  potassium 
salt,  as  it  contains  more  bromine  and  is  better  tolerated.  Bromides 
are  freely  soluble  in  water  and  in  alcohol.  Since  they  are  quite  salty 
to  the  taste  they  must  be  given  largely  diluted.  The  average  dose  is 
gr.  15  (1  gm.). 

The  bromides  are  used  in  any  conditions  where  there  is  cerebral  or 
nervous  excitement;  in  headaches,  injuries  to  the  brain,  meningitis, 
hysteria,  in  epilepsy  and  other  convulsive  disorders;  to  control  vomiting 
of  reflex  or  cerebral  origin.    They  are  of  special  value  in  the  nervous 


240  SEDATIVES 

and  febrile  disturbances  that  occur  so  readily  during  infancy.  They  may 
be  given  freely,  but  always  well  diluted  so  as  not  to  irritate  the  stomach.* 
The  importance  of  sedatives  in  the  management  of  first  dentition 
leads  to  a  brief  consideration  of  that  subject  following  the  antipyretic 
group. 

ANTIPYRETIC  GROUP. 

These  synthetic  agents  are  coal-tar  derivatives,  all  of  which  occur 
in  the  form  of  white  crystalline  powders. 

As  antip\Tetic  sedatives  they  have  power  to  lessen  temperature  in 
fever,  and  in  addition  they  have  anodyne  properties.  In  fact,  since  they 
have  come  to  be  recognized  as  sedatives,  being  on  that  account  inad- 
missible in  the  severe  fevers,  they  have  found  their  most  extensive  use 
in  the  treatment  of  headaches,  neuralgias  and  myalgias.  They  differ 
in  their  activity  and  safety. 

Antipyrina  [CUH12X2O]. — Average  dose,  gr.  5  (0.3  gm.).  This  is  the 
mildest  in  action  and  also  most  soluble.  It  is  of  some  value  as  an  anti- 
spasmodic in  the  treatment  of  infantile  convulsions  and  w^hooping-cough. 

Incompatibility. — Antip\Tine  is  incompatible  with  spirit  of  nitrous 
ether  and  with  solutions  of  carbolic  acid. 

Acetphenetidinum.— Ppienacetine  [CioHisNOa]. — Average  dose,  gr.  5 
(0.3  gm.).  This  is  more  powerful  than  antip^Tine,  but  comparatively 
safe.    It  is  practically  insoluble  in  water. 

Acetanilidum  [CgHgXO]. — Average  dose,  gr.  3  (0.2  gm.).  This  is  the 
most  powerful  of  the  group  and  least  safe.  It  is  sparingly  soluble  in 
water.  It  has  the  power  of  producing  alterations  in  the  blood  that  may 
cause  a  decided  appearance  of  cyanosis,  when  full  doses  are  taken 
repeatedly,  or  too  large  quantity  in  a  single  dose.  It  must  be  used 
cautiously,  if  at  all,  and  never  continuously  for  any  length  of  time.  The 
compound  powderf  is  a  useful  internal  analgesic.  The  caffeine  in  this 
may  aid  the  action  of   the  acetanilid,  but  it  chiefly  antagonizes  its 

*  While  the  bromides  in  their  ordinary  uses  are  without  danger,  it  should  not  be 
concluded  that  they  are  incapable  of  doing  harm.  Their  prolonged  use  is  not  desir- 
able, l)ecause  they  certainly  do  depress  cerebral  and  nerve  functions.  The  only 
unpleasant  symptom  commonlj^  attending  their  prolonged  use  is  the  occurrence  of 
pimples  upon  the  face  and  elsewhere,  which  is  believed  to  be  nature's  effort  to  ehm- 
inate  bromine. 

t  Pulvis  Acetanilidi  Composiius.     (N.  F.) 

Gm.  or  mils. 

I^. — Acetanilidi    ......       7 

Caffeinse 1 

Sodii  bicarbonatis 2  — M. 

Of  this  the  dose  is  1|  to  8  grains  (0.10-0.50  gm.). 


ANTIPYRETIC  GROUP  241 

depressant  action  upon  the  nervous  sj^stem  and  heart.     Locally,  acet- 
anilid  is  used  as  an  antiseptic  powder. 

Acid,  Acetylsalicylic. — ^Aspirin  (not  official). — Dose,  gr.  2-10  (0.12- 
0.60  gm.).  This  drug  has  come  into  popular  use  under  the  proprietary 
name  aspirin,  as  a  remedy  for  headache  and  for  various  slight  pains. 
It  should  be  employed  under  the  chemical  name. 

First  Dentition  Complications  and  Their  Treatment. 

It  has  been  remarked  that  children  bear  sedatives  relatively  better 
than  they  do  stimulants.  The  basis  of  this  fact  is  found  in  the  more 
sensitive  nervous  s^^stem  of  the  child.  If  we  compare  the  size  of  the 
brain  at  birth  with  the  total  weight  of  the  body,  we  find  that  its  relative 
size  greatly  exceeds  that  of  the  adult  brain.  At  the  same  time  its  function 
is  more  complex  in  that  it  is  concerned  with  the  process  of  development, 
which  becomes  less  active  later  on. 

In  consequence  of  this  greater  sensitiveness  of  the  child's  nervous 
system,  impressions  are  magnified;  not  only  do  slight  mental  impressions 
beget  fear  or  emotional  outbreak,  but  slight  nerve  irritation  which  in  an 
adult  would  be  unnoticed,  or,  at  most,  would  cause  slight  discomfort, 
in  a  child  may  produce  fever  and  convulsions.  Accordingly,  a  stimulant 
that  acts  through  exciting  or  irritating  a  function  or  tissue  will  disturb 
rather  than  soothe,  while  a  sedative  will  lessen  the  sensitiveness  of  nerve 
tissue  and  prevent  the  disturbances  of  function.  Although  occasionally 
so  much  depression  may  occur  as  to  call  for  stimulants,  as  a  rule  they 
may  be  dispensed  with  in  childhood,  while  sedatives  hold  a  place  of 
supreme  importance,  both  as  agents  to  prevent  and  to  control  the  serious 
nervous  disturbances  that  occur  so  easily  during  that  period  of  life. 

But  the  common  causes  of  infantile  disturbances  are  not  external, 
but  rather  the  irritations  that  proceed  from  functions  abnormally 
performed  within  the  body.  These  irritations  may  be  of  great  variety; 
but  as  we  see  the  extreme  sensitiveness  gradually  disappear  with  the 
development  of  the  child,  we  recognize  that  the  maximum  of  suscepti- 
bility to  irritation  exists  early,  or  during  the  period  corresponding  to 
first  dentition.  We  must  be  reminded  that  during  this  period  the  whole 
digestive  tract  is  being  prepared  for  a  more  complex  function,  that  of 
digesting  food  of  firmer  quality  and  greater  variety.  From  the  teeth 
downward  the  provisions  for  solution  and  absorption  of  food  are  being 
developed  and  adapted,  and  throughout  there  is  connection  with  the 
same  sensitive,  directing  and  controlling  central  nervous  system.  This 
16 


242  SEDATIVES 

is  often  shown  very  emphatically  by  the  occurrence  of  vomiting  or  con- 
vulsions after  the  self-indulgent  parent  has  enjoyed  seeing  the  infant 
sit  at  the  table  and  partake  of  the  common  family  dishes,  for  which  its 
digestive  apparatus  has  not  yet  been  prepared. 

Of  all  of  the  developmental  changes,  the  process  of  eruption  of  the 
teeth  is  the  most  visible;  and  it  has,  therefore,  been  blamed  too  indis- 
criminately for  the  disturbances  that  often  coincide  with  it.  It  is  so  easy 
to  satisfy  anxious  inquiry  by  the  statement  that  the  convulsion  in  a  given 
case  is  due  to  teething,  or,  if  that  is  improbable,  to  suggest  that  the  child 
may  have  worms. 

Without  denying  for  a  moment  that  abnormal  dentition  may  be  the 
cause  of  most  serious  disturbances,  we  must  take  a  comprehensive 
view  of  the  developmental  diseases  of  infancy  and  not  be  too  much 
influenced  by  what  we  may  see  at  either  end  of  the  digestive  tract. 
Teething  and  worms  each  have  a  pathologic  importance,  but  we  must 
not  allow  them  to  usurp  attention  that  belongs  to  factors  less  apparent, 
but  undoubtedly  more  important  in  many  cases.  We  must  hold  improper 
diet  to  be  an  influence  of  first  importance,  and  this  refers  not  only  to 
character  of  food,  but  to  quantity  and  to  intervals  of  feeding  as  well. 
Fermentation  and  putrefaction  of  food  materials,  and  even  infection  in 
the  intestinal  tract,  are  prominent  factors  of  disease  at  any  age;  but  in 
the  sensitive  child,  with  full  digestive  capacity  vmdeveloped,  such  factors 
are  of  superlative  importance. 

There  is,  however,  occasionally  seen  a  case  of  the  most  serious  general 
disturbance,  where  dentition  and  the  digestive  function  appear  to  be 
normal,  that  must  be  attributed  to  a  special  susceptibility  or  an  abnor- 
mality in  the  nervous  system  itself.  Again,  we  are  convinced  of  the 
prominence  of  the  central  nervous  system  as  a  primary  factor,  when  we 
see  a  child  of  unstable  nervous  constitution  have  a  convulsion  from  a 
cause  that  a  normal  child  will  successfully  resist. 

These  considerations  bring  into  prominence  the  part  of  treatment  that 
refers  to  the  nervous  system.  It  involves  temporary  prophylaxis  as 
well  as  relief,  and  includes  daily  supervision  of  the  child's  diet  and 
habits,  with  the  judicious  use  of  sedatives  in  order  to  lessen  the  irrita- 
bility of  nerve  centers,  so  that  they  may  respond  less  readily  to  irritating 
impressions. 

More  important  still  is  the  prophylaxis  that  fortifies  the  nerve  centers 
by  increasing  their  stability  or  tone.  Hygienic  measures,  including  an 
abundance  of  fresh  air,  daily  bathing  with  tepid  or  cold  water,  and 
proper  feeding,  meet  this  requirement. 


FIRST  DENTITION  COMPLICATIONS  243 

Probably  the  majority  of  children  suffer  with  irritability  and  feverish- 
ness  at  some  time  dm"ing  first  dentition.  As  a  rule  the  daily  discomfort 
becomes  more  marked  as  the  day  advances,  until  midnight  or  later, 
when  sleep  may  occur  with  frequent  interruptions.  Convulsion  or 
spasm  often  occurs  in  the  severer  cases.  The  treatment  of  the  condition 
will  include  the  hygienic  measures  previously  mentioned.  The  child 
should  be  taken  out  into  the  open  air  as  much  as  is  possible  during  the 
day  as  a  matter  of  routine  prophylaxis.  Fever  and  fretfulness  may  be 
lessened  by  cold  sponging  or  the  cool  bath.  Medicines  may  not  be 
needed  in  the  early  part  of  the  day,  but  later,  as  the  irritability  increases, 
the  bromides  may  be  given  freely  and  continued  until  the  child  rests.  If 
the  gums  show  great  hyperemia  over  advancing  teeth,  scarification  by 
means  of  a  clean  finger-nail  or  the  point  of  a  well-guarded  lancet  may 
afford  much  relief,  but  indiscriminate  lancing  of  the  gum  is  not  to  be 
advised. 

To  refer  again  to  the  medicines  that  are  useful,  both  arterial  and  nerve 
sedatives  have  their  place,  according  to  the  predominance  of  vascular 
or  nervous  disturbance.  The  tj^ical  arterial  sedative  drug  is  aconite. 
This  may  be  given  in  form  of  the  tincture,  in  a  dose  of  one-half  drop 
every  hour  until  the  circulatory  excitement  has  lessened.  Spirit  of 
nitrous  ether  may  be  combined  with  it  for  the  purpose  of  inducing 
sweating,  the  occurrence  of  which  will  reduce  the  fever. 

A  suggestive  prescription  for  a  child  one  to  two  years  old  is  as  follows : 

Gm.  or  mil. 

I^. — Tincturae  aconiti 1 1  (ITlxv) 

Spiritus  setheris  nitrosi       ...     30 1  (f§j) 

Glycerini 15 1  (fSiv) 

Aquae  cinnamonii  .      q.  s.  ad     60 1  (foij) — M. 

Sig. — -One-half  teaspoonful  in  water  every  hour  until  better. 

The  indications  for  .this  combination  would  be  a  full,  rapid  pulse  with 
fever,  and  the  medicine  should  be  lessened  or  discontinued  when  these 
s}Tiiptoms  abate.  Aconite  must  be  used  with  due  care,  for  it  is  a 
poisonous  drug  in  excessive  dose;  so  the  precise  indications  for  its  use 
and  the  favorable  result  of  its  action  should  determine  the  extent  of  its 
emplojTnent  in  any  case. 

In  most  cases,  the  danger  of  convulsions,  and  the  irritability  of  the 
nervous  system,  can  be  removed  by  the  bromides,  whose  action  is 
perfectly  safe.  Their  use  is  addressed  to  the  nervous  element,  which 
is  usually  \'ery  prominent,  while  the  circulatory  disturbance  is  secondary 
and  incidental.     Therefore,  the  use  of  a  bromide  will,  on  the  whole, 


244  SEDATIVES 

be  found  most  satisfactory,  because  it  meets  the  primary  indication  of 
lessening  the  sensitiveness  of  the  brain  centers  and,  at  the  same  time,  can 
be  used  continuously  in  full  doses  without  danger.  Sodium  bromide  is 
the  topical  agent  of  the  group,  but  it  must  always  be  given  well  diluted, 
so  as  to  avoid  irritating  the  stomach.  The  \\Titer  has  never  found  the 
drug  to  cause  vomiting  when  given  freely  diluted.  It  may  be  given 
in  a  dose  of  5  to  10  grains  (0.30-0.60  gm.)  to  a  child  one  year  old  in  the 
emergency  of  a  convulsion,  but  the  dose  for  continuous  administration  is  1 
to  3  grains  (0.06-0.20  gm.).    The  following  formula  is  simple  and  useful: 

Gm.  or  mil. 

I^. — Sodii  bromidi 2  (gr.  xxx) 

Syrupi 15  (f3iv) 

Aqu£e  cinnamomi    .      .      q.  s.  ad     60!  (f5ij) — M. 

Sig. — A  teaspoonful  every  hour  while  restless. 

The  above  formula  may  answer  every  purpose  of  necessary  medication 
in  the  simple  irritability  of  the  period  of  first  dentition.  Following  the 
directions  previously  given  in  respect  to  hygienic  treatment,  the  bromide 
need  not  be  given  until  the  beginning  of  the  daily  period  of  increased 
irritability,  which  occurs  toward  evening.  Then  it  may  be  given  hourly 
until  the  child  is  able  to  rest.  It  is  then  advisable  to  stop  the  medicine 
until  the  next  afternoon,  or,  at  least,  to  reduce  it  to  longer  intervals  of 
administration  during  the  morning. 

A  free  purge,  by  the  use  of  castor  oil,  is  usually  proper  also,  the  dose 
being  1  to  2  teaspoonfuls  (4-8  mils)  or  more,  according  to  age. 

Convulsions. — When  spasms  occur,  the  twitching  or  stiffness  of  the 
muscles  is  attended  by  unconsciousness.  This  shows  that  the  brain  is 
concerned  in  the  effects  of  the  irritation,  wherever  the  latter  originates. 
The  condition  must  be  treated  as  an  emergency,  the  aim  being  to  restore 
consciousness  and  relieve  the  convulsion.  The  head  is  usually  hot, 
while  the  extremities  may  be  cold.  The  treatment  will  embrace  several 
measures: 

1.  To  lessen  the  h\'peremia  and  sensitiveness  of  the  brain. 

2.  To  remove  the  source  of  irritation,  or  lessen  its  severity. 

3.  To  stop  the  convulsion  directly,  if  that  result  does  not  follow  the 
treatment  under  1  and  2. 

Under  the  first  heading  we  employ  means  of  bringing  blood  to  the 
surface  of  the  body,  such  as  the  hot  (very  warm)  bath  to  the  whole  body 
except  the  head.  If  the  latter  is  hot,  cold  applications  should  be  made 
to  it,  as  this  will  aid  in  securing  the  same  object  by  driving  the  blood 
from  the  brain.    ]\Iustard  flour  (1  to  4  teaspoonfuls,  mixed  first  with  a 


CONVULSIONS  245 

little  cold  or  tepid  water)  may  be  added  to  the  hot  bath  for  a  pronounced 
rubefacient  eftect. 

Meanwhile,  treatment  coming  under  the  second  heading  should  be 
employed.  ^Nhl\e  the  convulsion  is  present  it  may  not  be  possible  to  at 
once  remove  the  irritation,  which  may  be  in  the  digestive  tract;  but  the 
severity  of  its  effect  upon  the  brain  may  be  lessened  by  the  administra- 
tion of  sedatives.  An  excellent  combination  is  that  of  sodium  bromide 
and  antip\Tine,  the  latter  having  both  antispasmodic  and  antip^Tctic 
value,  and  producing  also  a  tendency  to  perspiration.  A  combination, 
giving  the  emergency  dose  of  sodium  bromide  as  5  to  10  grains  (0.30- 
0.60  gm.)  and  of  antipjTine  as  U  to  3  grains  (0.10-0.20  gm.)  according 
to  age,  is  here  given: 


Gm.  or  mil. 


I^. — Sodii  bromidi 10 

AntipyrinEe 3 

Glycerird 10 

Aquae  menthse  piperitse      q.  s.  ad  60 


(Sijss) 
(gr.  xlv) 
(fSijss) 
(f5ij)— M. 


Sig. — One-half  to  one  teaspoonful;  may  repeat  in  one  hour. 

If  the  child  does  not  swallow,  as  is  apt  to  be  the  case,  this  must  be 
given  carefully,  a  few  drops  at  a  time. 

A  full  dose  of  castor  oil  should  be  given,  if  swallowing  is  possible,  so 
that  any  irritant  in  the  digestive  tract  may  be  carried  onward.  It  is  not 
advisable  to  give  an  emetic  during  a  spasm,  for  fear  of  vomited  matter 
being  drawn  into  the  trachea. 

If  relief  does  not  follow  in  say  haK  an  hour,  treatment  coming  under 
the  third  heading  may  be  employed,  and  this  will  usually  be  the  cautious 
use  of  chloroform  by  inhalation,  the  object  being  to  relieve  the  spasm  by 
direct  action  upon  the  brain,  with  which  result  sleep  takes  the  place  of 
the  coma.  From  this  sleep  the  child  may  awake  relieved,  but  in  severe 
cases  it  may  still  remain  in  the  convulsion.  Spasms  can  usually  be  con- 
trolled by  chloroform,  but  its  continuous  inhalation  is  in  itself  danger- 
ous, so  that  reliance  for  permanent  relief  must  be  placed  upon  the  other 
measures  that  remove  the  source  of  irritation,  that  relieve  cerebral 
hj-peremia,  and  that  lessen  the  irritability  of  the  brain  centers  more 
permanently. 

Chloral  hydrate  is  often  used  by  rectum,  in  dose  of  a  few  grains  (1-5), 
when  convulsions  are  persistent. 

For  treatment  beyond  the  emergency  period,  the  bromide  and  anti- 
p}Tine  may  be  continued  at  the  intervals  necessary  to  prevent  restless- 
ness and  fever.  A  cathartic  should  be  employed,  unless  previously  given, 
to  ensure  emptying  of  the  digestive  tract,  where  the  irritation  may  have 


246  SEDATIVES 

originated.  For  this  purpose  castor  oil  is  our  first  choice,  being  efficient 
and  harmless.  Succeeding  the  hot  bath,  the  child  should  be  wrapped 
in  hot  blankets,  in  order  to  keep  the  blood  toward  the  surface  and  to 
favor  sweating. 

If  dentition  is  found  to  be  abnormal  or  difficult,  and  teeth  are  nearly 
ready  to  appear,  the  gums  may  be  scarified  as  mentioned  before.  But 
cutting  the  gums  over  teeth  that  are  not  likely  to  appear  for  several 
months  is  questionable  practice,  as  the  tissue  will  rapidly  heal,  and  may 
even  present  the  additional  barrier  of  scar  tissue  to  the  later  progress  of 
the  teeth.  When,  however,  the  gums  are  very  much  swollen  and  con- 
gested, scarification  may  be  advisable  independently  of  the  state  of 
progress  in  the  eruption  of  the  teeth. 

Other  means  of  accomplishing  the  objects  set  forth  above  may  be 
employed;  simply  the  outline  of  common  practice  is  here  given.  In  the 
cases  that  present  an  evident  infection,  the  treatment  will,  as  a  matter 
of  course,  vary  according  to  its  nature  and  the  indications  it  furnishes. 

Chloralum  Hydratum.     (Plate  XVI.) 

Chloral  [C2HCI3O — H2O]. — Chloral  hydrate  is  a  typical  hypnotic. 
It  is  used  to  induce  sleep  and  to  relieve  convulsions.  While  at  one  time 
it  was  our  only  efficient  hypnotic,  it  has  been  supplanted  to  a  consider- 
able extent  by  the  newer  and  safer  agents.  It  does  not  relieve  pain  in 
safe  doses.  Care  must  be  taken  not  to  exceed  the  safe  dose,  gr.  5-20 
(0.30-1.30  gm.),  as  it  may  easily  be  poisonous. 

Drugs  having  similar  action: 

Sulphonmethanum.^ — Sulphonal. 

Sulphonethylmethanum. — Trional. — These  drugs  are  safer  than  chloral 
but  slower  in  action.  Trional  is  more  soluble  than  sulphonal,  therefore 
usually  preferred,  but  either  must  be  given  several  hours  before  the  eft'ect 
is  desired.     Dose  of  each,  gr.  15-30  (1-2  gm.). 

Opium  and  its  Alkaloids.     (Plate  XVII.) 

Opium  is  the  concrete  exudation  obtained  by  cutting  the  unripe 
capsules  of  the  opium  poppy,  Papaver  somnifenim.  It  contains,  in  its 
fresh,  moist  condition,  at  least  9.5  per  cent,  of  morphine  (when  dried 
about  10-10.5  per  cent.),  besides  a  number  of  other  alkaloids. 

This  drug,  in  its  simple  form,  in  its  preparations,  or  as  represented  by 
its  chief  alkaloids,  morphine  and  codeine,  stands  at  the  head  of  all  agents 


PLATE    XVI. 


CHLORAL  HYDRATE. 

Dose:  gr.  5-20  (Gm.  .30-1.30J. 

Classified  as : 

Hypnotic. 
^Narcotic. 
Spinal  depressant. 
Cardiac  depressant. 

Physiologic  action  : 

Locally  applied,  it  is  somewhat 
irritant.  Internally,  it  re- 
sembles chloroform  in  ac- 
tion, except  that  it  is  not 
anesthetic  in  safe  doses. 

Nervous  System. 

Brain.  Depresses  cerebrum. 
Induces  sleep,  but  does  not 
relieve  pain. 

Medulla.  Depresses  respi- 
ratoiy  and  vasomotor  cen- 
ters. 

Spinal  cord.     Depresses  reflex  centers. 

Muscular  System.  Causes  general  muscular  weakness.  Probably 
depresses  muscular  coats  of  the  arterioles  by  direct  action. 

Circulation.     Eeduces  arterial  pressure  in  marked  degree. 
Heart.      Depresses  the  cardiac  muscle,  causing  slower  and 

weaker  action. 
Capillary  area.     Dilates  arterioles  by  depressing  vasomotor 

center,  and  probably  also  by  direct  depressant  action  upon 

the  muscular  coats  of  the  vessels. 

Hespiration.     Depresses  respiratory  center. 

Temperature.     Eeduced  by  full  doses. 

Metaboli.rm.  Destruction  of  proteids  is  increased  with  less  per- 
fect oxidation.  With  prolonged  administration  fatty  degen- 
eration of  various  organs  may  occur. 


Center 


The  blue  color  indicates  the  sedative  effects  of  Chloral. 
The  marked  depressant  action  upon  respiratory  and 
vasomotor  centers,  andupontheheart.  renders  Chloral 
much  more  dangerous  than  the  bromides,  whose  effects 
are  similar  in  kind. 


PLATE    XVTI. 


MORPHINE. 


Vagus  Center 

Vaso  Motor 

Center 
Cervical 
Sympathetic 


Solar  Plexus 


In  form  of  sulphate  or  hydro- 
chloride.   Gr.  |-|  (Gm.  .008-.015). 


Classified  as : 

Anodyne.  Narcotic. 

Physiologic  action  :^ 

The  action  of  morphine  is  essen- 
tially that  of  a  central  nerve 
depressant,  the  local  action 
of  the  drug,  wherever  applied, 
being  almost  nil.  C'h ildren  are  very  sensitive  to  th  is 
drug,  and,  if  needed,  it  shoidd  be  used  in  the  iveakest 
preparations,  and  in  less  than  the  proportional  dose. 

Nervous  System. 

Brain,      Depresses    cerebrum,    lessens   power   of 

attention,  and  diminishes  sensation  of  pain. 
Medulla.     Depresses  resjjiratory  center. 
Spinal  cord.     Does  not  perceptibly  influence 

the  cord. 

Note. — In  the  lower  animals  morphine  is  a  stimulant  to  the 
spinal  cord,  but  in  man  marked  depression  of  the  highly 
developed  brain  prevents  any  manifes- 
tation of  spinal  stimulation. 


Nerves.  The  peripheral  nerves 
are  not  alFected  bv  ordinary 
doses. 
Muscular  System.     Not  affected  by 

ordinary  doses. 
Circulation.     Not  much  influenced 
by  ordinary  doses. 
Heart.  Opinions  difier.  Any  in- 
fluence of  a  moderate  dose  must 
be  slight  and  probably  indirect. 
Large  doses  slow  the  heart  by 
stimulating  inhibition. 
Capillary  area.     jSTot  much 
influenced,  except  that  the  cu- 
taneous area  of  the  head  and 
neck  may  show  dilatation. 
Respiration.     Depressed  to  a  degree  corresponding  with 

size  of  dose. 
Eye.     Pupils  conti-acted  by  central  nerve  influence. 
Digestive  System. 

Stomacti.     Secretion  and  motility  lessened. 
Intestines.     Peristalsis  is  greatly  diminished. 
Elimination.     Secretions  generally  are  diminished,  except  the  pei-spiration.     The  drug  is 
partly   changed   in  the  system,  but  the  greater  part   is  eliminated  by  the  gastro- 
intestinal tract. 

1  For  poisoning  by  Opium  or  Morphine,  see  Table  of  Poisons  and  Antidotes. 


Pelvic  Plexus 


OPIUM  247 

for  the  relief  of  pain.  It  is  the  drug  of  first  importance  among  poisons, 
and,  next  to  alcohol,  is  the  one  most  frequently  used  in  the  way  of 
habit. 

Whenever,  therefore,  it  is  used,  poisoning  and  habitual  use  must  be 
guarded  against.  It  must  be  administered  with  some  caution  to  persons 
whose  susceptibilities  are  not  known,  and  as  a  rule  it  should  not  be  given 
to  infants  and  young  children.  The  prominence  of  the  brain  in  child- 
hood makes  the  child  exceedingly  susceptible  to  the  influence  of  this 
drug,  whose  action  is  chiefly  upon  the  brain  and  medulla. 

Fortunately  this  drug  is  little  needed  in  dental  practice,  because  it 
has  little  or  no  local  action.  Its  inutility  to  relieve  pain  by  local  applica- 
tion has  been  discussed  in  connection  with  arsenic.  Practically  the  only 
conditions  in  which  it  is  called  for  are  severe  pulpitis  or  pericementitis, 
which  fail  to  be  relieved  by  ordinary  local  treatment.  Here  a  few 
small  doses  of  the  drug  may  be  given  to  the  patient,  but  it  should  not  he 
prescribed  in  any  quantity,  for  fear  that  the  relief  obtained  might  lead 
to  an  easy  later  resort  to  the  drug,  with  formation  of  habit. 

In  the  rare  cases  where  it  becomes  necessary  to  administer  the  drug  to  a 
child,  a  much  smaller  dose  must  be  used  than  that  which  the  rule  would 
allow.*  The  preparation  used  mostly  with  children  is  the  camphorated 
tincture  of  opium,  commonly  known  as  paregoric,  which  contains  only 
0.4  per  cent,  of  opium.  The  rule  should  he  not  to  give  opium  or  morphine 
to  children. 

Persons  who  take  this  drug  habitually  acquire  a  tolerance  for  it,  that 
permits  them  to  take  very  large  doses.  While  the  usual  dose  of  morphine 
is  I  of  a  grain,  a  victim  of  the  habit  may  come  to  use  10,  20  or  30  grains 
daily.  Indeed,  there  is  the  need  of  increasing  doses  in  order  to  maintain 
the  original  effect,  even  where  it  is  taken  for  a  comparatively  short  time 
for  the  relief  of  pain.  This  shows  that  the  tolerance  of  the  drug  begins 
early.  Again,  when  the  system  has  become  accustomed  to  its  action,  it 
is  usually  difficult  to  stop  the  use  of  the  drug  without  some  discomfort  in 
the  way  of  unrest,  that  is  at  once  relieved  b}-  its  readministration.  On 
these  accounts  it  is  very  easy  to  acquire  the  opium  or  morphine  habit, 
and  very  difficult  to  overcome  it  without  the  fullest  cooperation  of  the 
victim  with  the  medical  adviser;  and  with  the  habit  once  thoroughly 
established,  subjection  to  the  discipline  of  a  hospital  will  usually  be 
required  in  order  to  succeed.  (For  poisoning  by  opium  or  morphine, 
see  Table  of  Poisons  and  Antidotes.) 

*  See  Cowling's  rule  in  chapter  on  Prescription  Writing. 


248  SEDATIVES 

Morphina  [C17H19NO3+H2O]. — This  alkaloid  was  isolated  from 
opium  and  described  by  Sertiirner  in  1816,  and  was  the  first  to  be  dis- 
covered of  the  whole  class  of  alkaloids.  It  has  stood  during  the  years 
since  as  the  most  representative  principle  of  opium;  and,  while  its  action 
varies  slightly  from  that  of  the  whole  opium,  the  uses  of  the  two  sub- 
stances are  identical,  except  that  for  hypodermic  use  a  morj)hine  salt  is 
always  employed.  Being  a  very  powerful  drug,  morphine  has  to  be 
used  with  caution.  For  its  action  in  detail,  see  Plate  XVII.  Its  official 
salts  are: 

Morphinse  Hydrochloridum,  soluble  in  17.5  parts  of  water. 

Morphinse  Sulphas,  soluble  in  15.5  parts  of  water. 

The  average  dose  of  each  of  these  is  gr.  |  (0.008  gm.),  which  may  be 
increased  as  needed  up  to  twice  the  quantity,  in  their  ordinary  use. 

Codeina  [Ci8H2iN03+H20]. — Soluble  in  88  parts  of  water.  Codeine 
is  less  powerful  and  less  depressing  in  action  than  morphine,  and  its 
after-effects  are  less  unpleasant.    Its  official  salts  are: 

Codeinse  Phosphas,  soluble  in  2.3  parts  of  water. 

Codeinse  Sulphas,  soluble  in  30  parts  of  water.  The  average  dose  of 
each  is  gr.  |  (0.03  gm.) 


PLATE    XVIII. 

CATHAKTICS. 

Cushny  classifies  cathartics  into  three  groups: 

1.  Mild  aperients,  the  castor  oil  group. 

2.  The  anthracene  purgatives. 

3.  The  jalap  and  colocynth  group. 

These  correspond  largely  to  groups  A,  B,  and  D  as 
given  below.  The  diagrams  are  intended  to  show  the 
different  ways  in  which  cathartics  may  act. 

It  is  not  possible  to  classify  strictly,  as  the  action  of 
some  is  too  extensive  to  be  limited  to  one  group. 

The  numbers  indicate  the  diagrams  that  represent 
what  is  believed  to  be  the  most  prominent  action  in 
case  of  each  drug,  not  always  the  complete  action. 

[For  preparations  and  doses,  see  Index  of  Drugs.] 


Group  A. 


LAXATIVES. 

(1) 


Fruits, 

Sugar. 

Sulphur. 

Purges  in  small  doses. 

Glycerin  (by  enema).     (2) 

Geoup  B.     PURGES. 

,    Aloe.     (1) 

Mercurials.     (4) 
Oleum  Ricini.     (4) 
Rhamnus  Frangula.     (1) 
Rhamnus  Purshiana.     (1) 

Group  C.     HYDRAGOGUES. 

Salines. 
Magnesii  Citras.     (3) 


Phenolphthalein.      (4) 
Rheum.     (1) 
Magnesia.      (3) 
Senna.      (1)    (4) 


Elaterinum.     (4) 


Magnesii  Sulphas.      (3^ 

Jalapa. 

(■1) 

Potassii  Bitartras.     (3) 

Senna. 

(1) 

Potassii  et  Sodii  Tartras 

•     (3) 

Sodii  Phosphas.     (3) 

Sodii  Sulpiias.     (3) 

Group  D.     DRASTICS. 

Coloeynthis.     (5) 

Olcimi  Tiglii. 

(5) 

Elaterinum.     (3)  (4) 

Podophyllum. 

(0) 

Jalapa.     (3)   (4) 

Scammoniuni. 

(5) 

Cambogia.     (5) 

1.   Motility  of  large 

intestine  stimulated. 


2.  Motility  of  rectum 
stimulated. 


The  red  color  shows  the  site  of  action,  and  indicates 
stimulation  of  motility  or  secretion. 


3.  Secretion  stimulated. 


4.  Motility  of  small 
intestine  stimulated. 


PLATE    XVIII. 

CATHARTICS. 

The  natural  provision  for  intestinal  evacuation  in- 
cludes three  factore : 

First.  A  certain  amount  of  indigestible  matter  in 
the  food. 

Second.  Peristaltic  motion  from  the  stomach  down- 
ward. 

Third.     A  certain  degree  of  fluidity  of  contents. 

A  decrease  of  any  one  factor  tends  to  constipation, 

while  an  increase  tends  to  diarrhoea. 

Cathartics  act  by  influencing  these  several  factors. 

Laxative  foods  act  by  reason  of  their  indigestible 
residue.  Almost  any  cathartic  may  have  simply  a 
laxative  effect  when  used  in  small  doses. 

Purges,  by  their  irritating  action,  stimulate  peris- 
talsis, the  milder  ones  acting  mainly  upon  the  large 
intestine  (1).  Some,  in  large  doses,  approach  drastics 
in  severity  of  action  (5).  The  absence  of  bile  dimin- 
ishes the  activity  of  podophyllum,  jalapa,  rheiun, 
senna,  and  scammonium. 

Hydragogues  act  in  two  ways : 

The  less  irritating  salines  cause  a  marked  increase 
of  fluid  by  determining  a  flow  of  serum  from  the  blood 
into  the  intestine  (3).  A  low  blood-pressure  diminishes 
their  activity. 

The  more  irritating  hydragogues  stimulate  very 
promptly  peristalsis  of  the  small  intestine,  with  the 
result  that  the  fluid  contents  are  hurried  onward  and 
absorption  is  lessened  (4).  Secretion  also  may  be  in- 
creased.    Copious  liquid  stools  result. 

Drastics  stimulate  powerfully  the  peristaltic  move- 
ment of  the  whole  tract  (5),  causing  prompt,  frequent 
stools,  with  severe  gi-iping.  In  large  doses  they  act  as 
irritant  poisons,  and  may  cause  contractions  in  the 
gravid  uterus. 

Cholagogues  favor  the  flow  of  bile  into  the  duodenum, 
^       probably  through  the  increased  peristalsis.      The  in- 
-J;Z-      fluence  of  cathartics  upon  the  function  of  the  liver 
seems  uncertain  and  indirect. 


Motility  of  whole  intestinal 
tract  stimulated. 


The  red  color  shows  the  site  of  action,  and  indicates 
stimulation  of  motilitv  or  secretion. 


CHAPTER  XVIII. 
ELIMINATn:ES. 

A  GROUP  of  functions  that  are  liable  to  disorder  in  connection  ^Yith 
any  general  disease,  comprises  those  that  secure  the  discharge  of  waste 
or  used-up  matters  from  the  body.  These  functions  are  called  elimi- 
native,  and  the  organs  chiefly  concerned  in  their  activity  are  the  skin, 
the  kidneys,  the  intestines  and  the  lungs.  Eliminatims  are  those 
agents  that  increase  the  eliminative  activity  of  these  several  avenues 
of  excretion. 

Cathartics  are  agents  that  induce  active  evacuation  of  the  intestines. 
(See  Plate  XVIII.) 

Diuretics  increase  the  activity  of  excretion  by  the  kidneys. 

Diaphoretics  are  agents  that  induce  sweating. 

Emetics  are  agents  that  cause  vomiting.  Their  action  is  not  so  purely 
eliminative,  as  vomiting  is  not  a  normal  eliminative  function,  but  rather 
a  result  of  irritation,  or  a  symptom  of  disease.  Their  eliminative  value 
is  seen  mainly  when  a  poison  or  foreign  substance  requires  to  be  removed 
from  the  stomach. 

Expectorants  are  agents  that  increase  the  secretion  of  the  air  passages. 
In  a  study  of  the  subject  of  elimination,  we  observe  a  certain  comple- 
mentary relation  between  the  activity  of  the  skin  and  of  the  kidneys. 

A  certain  amount  of  water,  holding  excretory  matter  in  solution,  passes 
out  of  the  body  daily,  chiefly  by  the  skin  and  kidneys;  and,  while  the 
solids  are  separated  from  the  blood  chiefly  by  the  kidneys,  the  amount 
of  water  which  they  excrete  varies  greatly,  being  influenced  especially 
by  the  activity  of  the  skin.  In  summer,  when  perspiration  occurs  freely, 
the  urine  is  scanty  in  quantity  but  concentrated;  while  in  winter,  when 
the  cool  temperature  lessens  cutaneous  elimination,  the  water  passes  out 
mainly  by  the  kidneys,  causing  a  large  amount  of  diluted  urine.  In  the 
application  of  diaphoretics  and  diuretics  we  should  take  into  account  this 
relation,  for  some  agents  will  act  in  either  way.  For  example,  sphit  of 
nitrous  ether,  when  taken  in  the  evening,  with  the  skin  being  kept  warni 
during  the  night,  will  induce  sweating;  whereas,  when  it  is  given  in  the 
morning,  followed  by  exposure  to  a  cool  out-of-door  temperature,  it 
will  act  as  a  diuretic.  To  some  extent  bowel  activity  also  may  relieve 
the  kidneys.     We  have,  therefore,  two  resources  in  the  direction  of 


250  ELI  MIX  A  TI VES 

vicarious  elimination  when  the  kidneys  are  disabled — viz.,  by  catharsis 
and  by  diaphoresis;  though  they  are  only  substitutes  and  much  less 
efficient. 

The  lungs  eliminate  volatile  substances  chiefly. 

DIURETICS. 

Diuretics  increase  activity  of  the  kidneys  in  several  ways. 

1.  Some  alter  the  composition  of  the  blood  by  increasing  its  salinity. 
The  potassium  salts  especially  act  in  this  way.  Potassium  is  less  needed 
by  the  system  than  sodium ;  therefore  a  moderate  dose  means  an  excess 
in  the  blood,  which  naturally  passes  out  by  the  kidneys,  carrying  con- 
siderable water  with  it.  This  explains  why  potassium  salts  are  diuretic 
while  sodium  salts  are  not.  The  most  valuable  for  this  purpose  are  the 
following : 

Potassii  Acetas. — This  salt  is  deliquescent.  Average  dose,  gr.  15  (1  gm.). 

Potassii  Citras. — This  salt  is  deliquescent.    Average  dose,  gr.  15  (1  gm.) 

Potassii  Bitartras. — Cream  of  Tartar. — Average  dose,  gr.  30  (2  gm.). 

Potassii  Nitras. — Nitre. — Saltpetre. — Average  dose,  gr.  8  (0.5  gm.). 

Of  these  potassium  salts,  the  acetate,  citrate  and  bitartrate  are  harm- 
less when  given  properly  diluted,  and  their  use  may  be  continued  indefi- 
nitely. The  bitartrate  is  cathartic  when  given  in  large  dose.  The 
nitrate  is  used  with  caution,  as  it  is  believed  to  be  more  stimulating 
to  the  kidney. 

2.  Another  class  of  diuretics  act  chiefly  by  increasing  arterial  pressure. 
In  many  cases  where  elimination  is  deficient,  it  is  because  the  circula- 
tion is  weak  and  the  arterial  pressure  low;  in  fact,  the  balance  of  blood 
pressure  has  been  transferred  from  the  arterial  to  the  venous  side,  which 
causes  dropsy  or  edema.  The  best  kind  of  diuretic  here  may  be  an 
agent  that  restores  the  balance  of  pressure  to  the  arterial  side,  even 
though  it  does  not  directly  stimulate  the  kidney  structure.  The  follow- 
ing drugs  act  in  this  way: 

Digitalis. — The  leaves  of  Digitalis  purpurea. 

Strophanthus. — ^The  seeds  of  Strophanthvs  kombe  and  of  S.  hispidus. 

Sparteinse  Sulphas. — A  liquid  alkaloid  from  Cytisus  scoparivs. 

Scilla. — ^^QUiLL. — The  bulb  of  Urginea  maritina. 

(For  preparations  and  doses  of  these,  see  Index  of  Drugs.) 

3.  Still  other  diuretics  act  by  stimulating  the  secreting  structure  of  the 
kidney,  leading  to  a  better  excretion  of  solids.  These  are  sometimes 
called  stimulant,  or  specific,  diuretics. 

Examples  of  this  class  are: 

Spiritus  ^theris  Nitrosi. — Spirit  of  Nitrous  Ether. — Siveet  Sjnrit 
of  Xitre. 


EMETICS  251 

Buchu. — The  leaves  of  Barosma  hetulina  or  of  B.  serratifolia. 

Cubeba. — CrBEB. — The  dried,  unripe  fruit  of  Piper  Cubeba. 

Oleum  Juniperi. — Oil  of  Juniper  Berries. 

Oleum  Terebinthinae. — Oil  of  Turpentine. 

Potassii  Nitras. — Saltpetre. 

Theobrominee  Sodio-salicylas. — Dmretin. 

Uva  Ursi. — The  leaves  of  Ardostaphylos  Uva  ursi. 

(For  preparations  and  doses  of  these,  see  Index  of  Drugs.) 

The  above  division  into  classes  is  convenient,  but  not  absolute,  as 
some  diuretics  act  in  more  than  one  way.  Such  are  classed  according  to 
their  more  prominent  action. 

DIAPHORETICS. 

The  agents  that  induce  sweating  are  well  represented  by  the  following: 

Spiritus  ^theris  Nitrosi  (with  skin  kept  warm). 

Pilocarpinse  Hydrochloridum. 

Pilocarpinse  Nitras. 

(For  doses  and  uses,  see  Index  of  Drugs.) 

Heat  in  form  of  hot-air  cabinet  bath,  hot-air  bed  bath,  hot  mustard 
foot  bath,  and  hot  teas  of  various  kinds  drunk  in  good  quantity,  is  a 
most  important  and  probably  the  most  reliable  agency  for  inducing 
sweating. 

EMETICS. 

The  agents  that  induce  vomiting  act  either  by  irritating  the  mucous 
membrane  of  the  stomach,  causing  reflex  contraction  of  stomach,  dia- 
phragm, and  abdominal  muscles,  or,  by  acting  directly  upon  the  vomiting 
center  in  the  medulla,  they  stimulate  the  same  motor  activities. 

The  following  act  reflexly  by  irritating  the  stomach: 

Sinapis. — INIustard. — The  ordinary  ground  mixture  of  black  and 
white  mustard  seed  is  employed,  a  tablespoonful  or  less  stirred  up  in  a 
glass  of  cold  water. 

Ipecacuanha. — The  root  of  Cephcelis  Ipecacuanha  or  of  C.  acuminata. 

Zinci  Sulphas. — Sulpil\te  of  Zinc. 

Cupri  Sulphas. — Sclpil\te  of  Copper. 

Antimonii  et  Potassii  Tartras. — Tartar  E:metic. 

The  first  three  are  commonly  used,  being  reliable  and  safe.  Sul- 
phate of  copper  is  more  irritating,  therefore  capable  of  doing  harm. 
Tartar  emetic  is  also  very  depressing,  and  has  often  caused  poisoning. 

(For  preparations  and  doses  of  these,  see  Index  of  Drugs.) 

Common  salt  and  powdered  alum  also  are  useful  emetics. 


252  ELIMINATIVES 

Apomorphinse  Hydrochloridum. — Hydrochloride  of  Apomorphine. — 
This  is  an  artificial  alkaloid  derived  from  morphine.  As  it  acts  upon 
the  vomiting  center,  it  may  be  given  hypodermically  in  cases  of  poison- 
ing by  opium  or  other  narcotics,  where  the  patient  does  not  swallow. 
The  dose  h>T)odermically  is  gr.  ^  ^  (0.006  gm.). 

(See  Index  of  Drugs.) 

The  use  of  emetics  has  lessened  somewhat  since  washing  out  of  the 
stomach  (lavage)  has  become  such  a  common  procedure.  The  latter 
has  the  advantages  of  emptying  the  stomach  without  an}'  delay  and 
permitting  a  thorough  washing  of  its  walls. 

The  uses  of  syrup  of  ipecacuanha  with  children  merit  special  atten- 
tion. In  cases  of  spasmodic  croup  it  is  employed,  in  emetic  dose,  for  the 
purpose  of  securirLg  complete  relaxation  of  the  respiratory  apparatus, 
with  relief  of  the  spasm  in  the  larynx.  Also  in  the  treatment  of  bron- 
chitis in  children  too  young  to  expectorate,  its  emetic  action  is  employed 
in  order  to  expel  mucus  from  the  air  passages,  where  its  accumulation 
interferes  with  breathing  and  provokes  coughing.  For  both  purposes 
mentioned  sjTup  of  ipecacuanha  is  given  in  doses  of  one-half  to  one 
teaspoonful  (2-4  mils.),  repeated  in  half  an  hour  if  necessary,  the  pur- 
pose being  to  induce  vomiting. 

EXPECTORANTS. 

Expectorants  increase  the  secretion  of  the  air  passages.  Some  of  the 
emetic  drugs,  and  especially  the  following,  may  be  expectorant  in  smaller 
doses : 

Ipecacuanha. — Ipecac. 

Apomorphinae  Hydrochloridum. 

Antimonii  et  Potassii  Tartras. — Tartar  Emetic. 

(For  preparations  and  doses,  see  Index  of  Drugs.) 

Ammonia  and  ammonium  preparations  are  largely  eliminated  by  the 
air  passages,  and  they  at  the  same  time  stimulate  the  mucous  secretion. 
The  chief  ones  of  value  are  the  two  following,  the  first  of  which  is  also  a 
general  stimulant,  and  used  on  this  account  in  the  more  depressing 
respiratory  diseases,  such  as  pneumonia. 

Ammonii  Carbonas. 

Ammonii  Chloridum. 

Other  expectorants,  stimulating  in  nature,  include 

Cubeba. — Cubeb. 

Scilla. — Squill. 

(For  preparations  and  doses,  see  Index  of  Drugs.) 


CHAPTER  XIX. 
ANIMAL  DRUGS. 

Substances  of  animal  origin  have  from  time  to  time  found  a  place  in 
our  materia,  medica.  Some  have  fallen  largely  into  disuse,  such  as  musk 
and  castor,  of  the  antispasmodic  class.  More  recently  the  digestive 
enzjTiies  have  been  recognized  as  having  a  positive  value  and,  while  both 
pepsin  and  pancreatin  are  official,  even  their  use  has  diminished  very 
much  with  a  better  knowledge  of  the  physiology  of  digestion.  But  the 
past  decade  has  seen  the  fuller  development  of  preparations  of  some  of 
the  ductless  glands,  representing  internal  secretions  of  the  greatest 
importance  to  the  nutrition  and  well-being  of  the  body.  These  will  be 
discussed  as  fully  as  the  scope  of  this  book  demands.  They  are  employed 
in  the  form  of  the  dried  gland  or  of  an  extract  of  the  gland  tissue  and  in 
case  of  the  suprarenals  an  active  principle  (epinephrine)  has  been 
isolated. 

Thyroideum  Siccum. — Dried  Thyroids. — The  th}Toid  glands  of 
animals  used  as  food  by  man,  dried  and  powdered.  Average  dose  gr.  1^ 
(0.1  gm.). 

This  substance  is  absolutely  essential  in  the  treatment  of  conditions 
due  to  deficient  th\Toid  secretion,  the  disease  known  as  myxedema 
yielding  very  promptly  to  its  use,  while  the  more  advanced  state  of 
malnutrition  known  as  cretinism,  if  recognized  earh^,  shows  the  most 
remarkable  improvement  under  its  use.  Since  these  conditions  are  due 
to  deficiency  of  th\Toid  secretion,  it  follows  that  the  treatment  must  be 
continued  through  life. 

Suprarenalum  Siccum. —  Dried  Suprarenals. — ^The  suprarenal  glands 
of  animals  used  as  food  by  man,  dried  and  powdered.  Average  dose 
gr.  4  (0.25  gm.). 

The  value  of  this  substance  depends  upon  its  power  of  stimulating, 
by  local  action,  structures  innervated  by  the  sympathetic  nerves, 
particularly  the  unstriped  muscles  of  the  arterioles  and  the  accelerator 
terminations  in  the  heart.  For  emergency  stimulation  of  the  circulation 
it  is  given  intravenously,  since  administration  by  stomach  or  hypo- 
dermically  produces  very  little  effect. 

The  local  action  of  this  agent  is  very  important  in  the  treatment  of 


254  ANIMAL  DRUGS 

hemorrhage  from  small  vessels  and  in  connection  with  cocaine  or  other 
analgesics.  In  the  latter  use,  chiefly  by  hypodermic  injection  with  the 
analgesic,  its  vasoconstrictor  action  prevents  rapid  absorption  of  the 
latter,  holding  it  to  the  desired  locality,  thus  rendering  its  action  more 
efficient  and  safer.  The  active  principle  of  the  suprarenal  gland  (epineph- 
rine, Abel)  is  used  largely  in  form  of  the  1  :  1000  solution  called 

Solution  of  Adrenaline  Chloride*  (not  official). — This  may  be  added  to 
analgesic  solutions,  at  the  time  of  use,  within  the  limit  of  the  internal 
dose  of  TH,  10-30  (0.60-2  mils).  In  nosebleed  and  other  small  hemor- 
rhages this  is  one  of  our  most  valuable  local  agents. 

Hypophysis  Sicca. —  Dried  Pituitary  Body. — The  dried  posterior  lobe 
of  the  pituitary  body  of  cattle.    Average  dose  gr.  |  (0.03  gm.). 

The  pituitary  body  seems  to  be  related  to  the  function  of  growth,  its 
overaction  causing  an  abnormal  and  excessive  enlargement  of  part  or 
whole  of  the  body,  the  conditions  known  as  acromegaly  and  gigantism. 
Its  therapeutic  value,  however,  depends  chiefly  upon  its  power  to 
stimulate  unstriped  muscle,  whereby  it  induces  constriction  of  the 
peripheral  arterioles,  stimulates  motility  of  stomach  and  intestines, 
increases  the  secretion  of  milk  and  stimulates  uterine  contractions.  In 
ordinary  doses  it  has  little  or  no  central  action  upon  the  nervous 
system.  It  is  administered  in  solution  either  hypodermically  or  intra- 
venously, since  it  has  little  effect  when  given  by  mouth.  The  official 
solution  is 

Liquor  Hypophysis. — Solution  of  Pituitary  Body. — Average  dose:  Ttl  15 
(1  mil). 

Pituitrin,  hypophysin,  etc.,  are  commercial  extracts  of  the  drug. 

Serum  Antidiphthericum  Purificatum. —  Diphtheria  Antitoxin. 

Serum  Antidiphthericum  Siccum. — Dried  Diphtheria  Antitoxin. — Aver- 
age dose:  hypodermic,  10,000  units;  protective,  1000  units. 

This  agent  consists  of  certain  antitoxic  substances  obtained  from  the 
blood  serum  of  the  horse,  after  subjecting  the  animal  to  increasing  doses 
of  diphtheria  toxin,  whereby  immunity  against  the  toxin  is  secured. 
The  purified  antitoxin,  as  commonly  used,  either  hypodermically  or 
intravenously,  has  the  antitoxic  globulins  dissolved  in  physiologic 
solution  of  sodium  chloride  and  has  a  potency  of  not  less  than  250 
antitoxic  units  per  mil. 

Antitoxin  is  now  fully  relied  upon  both  in  treatment  of  diphtheria 
and  to  immunize  against  the  disease. 

*  This  substance  is  also  marketed  under  various  other  names,  such  as  adnephrine, 
suprarenine,  hemostasine,  etc. 


ANIMAL  DRUGS  255 

Serum  Antitetanicum  Purificatimi. — Tetanus  Antitoxin. 

Serum  Antitetanicum  Siccum. —  Dried  Tetanus  Antitoxin. — Average 
dose:  hypoderraic,   10,000  units;  protective,    1500   units. 

This  agent  consists  of  certain  antitoxic  substances  obtained  from  the 
blood  serum  of  the  horse,  after  a  process  of  immunizing  the  animal 
against  tetanus  toxin.  Used  commonly  in  the  physiologic  sodium 
chloride  solution  (purified  form)  it  is  found  more  efficient  as  a  preventive 
than  as  a  curative  agent;  hence,  it  is  common  practice  to  inject  hypo- 
dermically  a  protective  dose  after  any  injury  that  presents  the  prob- 
ability of  tetanus  infection.  For  some  years  past  Fourth-of-July 
injuries  have  been  thus  treated,  with  the  result  that  cases  of  tetanus, 
formerly  very  frequent  after  these  injuries,  have  been  reduced  to  a  small 
percentage.  Its  use  after  the  disease  has  developed  is  less  successful, 
and  here,  as  an  aid  to  other  treatment,  it  is  administered  intravenously 
or,  better  still,  injected  directly  into  the  spinal  canal.  Tetanus  anti- 
toxin has  a  potency  of  100  units  per  mil. 

Pepsinum. — Pepsin. — ^White  or  yellowish  scales  or  powder,  being  a 
mixture  containing  a  proteolytic  enzyme,  obtained  from  the  stomach-wall 
of  the  hog.  It  should  digest  not  less  than  3000  times  its  weight  of  egg 
albumen.    Average  dose,  gr.  8  (0.5  gm.). 

While  meeting  certain  indications  of  deficient  digestive  power  in  the 
stomach,  pepsin  is  now  used  much  less  than  formerly.  It  is  often  given 
in  an  acid  solution  in  imitation  of  the  gastric  juice. 

Pancreatinum. — Pancreatin. — Extract  of  Pancreas. — A  cream-colored 
powder  containing  amylopsin,  trypsin  and  steapsin,  obtained  from  the 
pancreas  of  the  hog  or  the  ox.  It  should  change  not  less  than  25  times 
its  weight  of  starch  into  soluble  carbohydrates.  Average  dose,  gr.  8 
(0.5  gm.). 

Since  pancreatin  contains  at  least  three  enzymes,  it  has  a  wider 
application  to  digestive  diseases  than  does  pepsin.  It  is  administered 
usually  in  powder  form,  with  addition  of  sodium  bicarbonate  to  insure 
an  alkaline  medium  for  its  action,  in  imitation  of  conditions  found 
normally  in  the  small  intestine.  In  intestinal  indigestion  at  any  age 
it  is  found  useful,  and  it  is  often  employed  to  predigest  (peptonize) 
food,  especially  milk,  for  administration  either  by  mouth  or  by  rectum. 

It  is  regarded  as  irrational  to  use  pepsin  and  pancreatin  together, 
since  the  former  requires  an  acid  medium  for  its  action,  while  the  latter 
acts  best  in  an  alkaline  medium. 


CHAPTER   XX. 
DENTISTRY  DURING  PREGNANCY. 

The  decision  of  the  question  as  to  performing  dental  operations 
during  gestation  must  usually  rest  upon  the  combined  opinion  of  family 
physician  and  dentist.  It  is  easy  to  formulate  rules  of  practice,  but 
these  may  just  as  easily  be  disregarded  in  the  presence  of  an  urgent 
condition.  It  must  always  be  remembered  that  gestation  is  usually 
a  normal,  physiologic  process,  which  should  permit  liberty  of  treatment 
within  sensible  limits  instead  of  imposing  too  strict  limitations. 

The  factors  that  form  the  basis  for  the  exercise  of  caution  are: 

1.  Increased  nervous  susceptibility  of  the  pregnant  woman,  particu- 
larly in  the  early  months. 

2.  Danger  of  disturbance  of  the  process  of  gestation  through  shock 
or  violence. 

There  may  also  be  noted  the  prevalent  belief  that  strong  impressions 
upon  the  senses  may  be  the  cause  of  birthmarks. 

This  belief,  though  it  has  the  support  of  some  authorities,  cannot 
be  given  any  physiologic  basis.  The  fact  that  no  nervous  connection 
exists  between  mother  and  embryo  weighs  heavily  against  it;  for  that 
fact  requires  the  assumption  that  some  blood  condition  of  the  mother 
is  capable  of  influencing  in  a  peculiar  way  some  particular  embryonic 
tissue;  in  other  words,  to  exert  a  selective  influence. 

Assuming  such  an  improbability,  it  still  could  not  be  believed  that 
tissue  once  normally  formed  can  be  subject  to  such  influence;  therefore, 
it  is  safe  to  state  that  any  detrimental  impression  can  be  potent,  if  at 
all,  only  during  the  early  weeks  of  gestation,  the  time  of  conception 
doubtless  being  the  most  impressionable  period. 

The  period  of  greatest  liability  to  possible  dangers  of  this  kind  being 
then  at  a  time  when  it  is  as  yet  uncertain  whether  pregnancy  exists,  it, 
indeed,  being  oftentimes  unexpected,  it  is  evident  that  we  can  exercise 
practically  no  control  in  this  matter;  and  for  the  dental  practitioner  to 
observe  the  general  rules  to  be  given  later,  should  suffice  as  far  as  he 
can  be  concerned. 

Coming  to  the  practical  question  of  dental  operations,  we  recognize 
certain   periods   of  greater   susceptibility   to   disturbance.     The   first 


DENTISTRY  DURING  PREGNANCY  257 

three  months  constitute  the  period  of  greatest  nervous  instability,  as 
shown  by  reflex  vomiting,  which  occurs  in  the  healthiest  women  as 
well  as  in  the  less  vigorous.  The  system  is  accommodating  itself  to  the 
new  order  of  affairs.  Certain  organs  are  undergoing  change  to  accom- 
modate new  or  increased  function.  Latent  weakness  of  organs  is  apt 
to  become  manifest.  It  is  the  period  which  usually  determines  whether 
accommodation  and  compensation  can  sufficiently  occur,  for  it  is  the 
period  of  most  frequent  failure;  which  is  to  say  that  abortion  occurs 
most  frequently  during  the  first  three  months. 

This  period  once  passed  without  accident,  health  and  vigor  improve, 
so  that  after  the  fourth  month  the  state  of  health  is  often  the  best  ever 
experienced.  This  satisfactory  status  continues  to  the  end  of  gestation; 
except  that  during  the  last  two  months  there  is  danger  of  premature 
labor  being  induced  through  shock  or  violence. 

These  considerations  lead  us  to  divide  gestation,  for  our  present  pur- 
pose, into  three  periods,  as  follows : 

1.  First  three  months — the  susceptible  and  accommodative  period. 

2.  Fourth  to  seventh  month  inclusive — the  period  of  vigorous  health. 

3.  Last  two  months — the  period  of  increasing  discomfort. 

During  the  first  period  any  considerable  operation  should  be  avoided, 
unless  absolutely  necessary.  Prolonged  filling  operations,  or  extrac- 
tion of  a  tooth,  had  better  be  postponed  until  after  this  unstable  period 
of  accommodation  and  great  susceptibility.  But  it  must  be  plain  that 
even  the  extraction  of  a  tooth  may  occasion  less  disturbance  than  tooth- 
ache prolonged  through  several  days  with  sleepless  nights.  In  case 
of  an  extraction  being  positively  necessary,  an  anesthetic  may  be  used 
at  the  discretion  of  the  family  physician. 

From  the  foregoing  it  appears  that  the  time  of  choice  for  dental 
operations  lies  within  the  second  period,  and  preferably  during  the 
fifth  and  sixth  months.  At  this  time  the  general  health  is  at  its  best 
and  the  danger  of  disturbing  gestation  at  its  minimum.  There  is  no 
good  reason  why  any  necessary  dental  work  should  not  be  done  during 
several  months  at  this  time.  There  should  be  every  care  taken  to  avoid 
the  infliction  of  pain,  and  short  sittings  should  be  the  rule.  Anesthesia 
of  short  duration  is  admissible  when  necessary,  the  choice  of  agent 
to  be  left  to  the  family  physician.  It  should,  however,  be  noted  that 
all  during  gestation  there  is  an  essential  tendency  to  toxemia  upon  slight- 
est provocation,  because  of  the  extra  demand  upon  nutrition  and  elimi- 
nation. It  is  a  question,  therefore,  whether  any  anesthetic  should  be 
used  that  will  increase  this  tendency  or  add  to  its  results.  The  exclu- 
17 


258  DENTISTRY  DURING  PREGNANCY 

sion  of  air  during  the  induction  of  anesthesia,  as  is  common  with  nitrous 
oxide,  should  be  avoided,  as  directly  contributing  to  auto-intoxication, 
and  this  means  that  inhalers  that  do  not  allow  free  access  of  air,  or 
those  that  require  the  rebreathing  of  expired  air,  should  not  be  used. 

In  the  third  period  a  restrained  posture  in  the  dental  chair  for  any 
length  of  time  may  mean  serious  discomfort.  Add  to  this  the  danger, 
though  slight,  of  provoking  premature  labor,  and  we  are  brought  to 
the  conclusion  that  dental  operations  should  be  avoided  during  the  last 
two  months,  if  possible.  ^Yhere  dental  work  seems  necessary  during 
this  period,  the  operator  should  consult  the  family  physician  before 
undertaking  the  same;  for  it  may  be  that  there  are  unfavorable  points 
in  the  patient's  condition  that  are  known  only  to  her  physician. 

Care  of  the  Mouth  during  Pregnancy. — Because  of  the  abundantly 
observed  fact  that  caries  of  the  teeth  makes  rapid  progress  in  the  teeth  of 
pregnant  women,  care  of  the  mouth  with  a  view  to  prevention  of  caries 
becomes  very  important. 

It  was  earlier  believed  that  the  tooth  structure  suffered  a  change  by 
giving  up  some  of  the  mineral  salts  to  meet  the  needs  of  the  growing 
embryo.  If  this  were  true  it  would  seem  that  Xatm-e  had  shown  her- 
self seriously  at  fault  in  failing  to  provide  sufficiently  for  the  assimilation 
of  materials  that  are  very  abundant  in  the  foods  commonly  taken.  How- 
ever, it  has  been  shown  by  Black*  that  the  teeth  of  females  during  the 
period  of  life  when  child-bearing  occurs,  average  slightly  harder  and 
denser  than  the  teeth  of  males  during  the  same  period  of  life;  and  the 
conclusion  follows  that  the  prevalence  of  caries  must  be  explained  in 
some  other  w^ay. 

When  we  consider  the  active  part  that  acids  take  in  the  production 
of  caries,  it  is  only  necessary  to  point  out  that  the  usual  vomiting  of 
pregnancy,  which  occurs  during  the  first  three  months,  brings  acid 
stomach  contents  daily,  and  oftener,  into  the  mouth  and  in  contact  with 
the  teeth,  and  we  have  the  basis  of  a  rational  explanation  of  the  rapid 
progress  of  caries.  Also,  with  the  attention  fixed  upon  other  matters, 
and  with  more  or  less  general  indisposition,  the  teeth  are  very  likely  to 
be  neglected  just  at  a  time  when  they  need  extra  care. 

Upon  the  basis  of  this  explanation  the  proph^daxis  will  be  simple 
and  efficient.  If  we  are  in  a  position  to  advise  early,  education  of 
the  patient  comes  first;  then  the  simplest  kind  of  an  alkaline  mouth- 
wash, such  as  lime-water  or  saturated  solution  of  borax  or  of  sodium 

*  Dental  Cosmos,  May,  1895. 


CARE  OF   THE  MOUTH  DURING  PREGNANCY  259 

bicarbonate,  used  freely  at  frequent  intervals  and  immediately  after 
every  occurrence  of  vomiting,  and  continued  diu'ing  the  early  months, 
ought  to  suffice  in  a  special  way.  The  usual  directions  as  to  general  care 
of  the  mouth  and  teeth  will,  of  course,  be  emphasized. 

Unfortunately,  even  the  physician  is  not  consulted  in  the  average  case 
until  the  period  most  important  for  prophylaxis  is  past;  therefore,  every 
suitable  opportunity  of  educating  mothers  and  those  likely  to  be  mothers, 
upon  these  points,  should  be  improved. 


PART  ly. 

CHAPTER   XXI. 
PRESCRIPTIOX  WRITING. 

The  T\Titing  of  prescriptions  is  an  art  that  requires  practice  for  its 
perfection.  Its  basis  must  be  a  certain  attainment  in  the  knowledge  of 
drugs,  their  activities  and  their  doses,  as  related  to  their  selection  for 
certain  diseases;  also  of  their  physical  and  chemical  qualities  as  related 
to  form  of  administration  and  possible  combination  with  other  sub- 
stances. \Yhile  it  is  easy  to  order  a  simple  solution  of  a  common  sub- 
stance, the  forming  of  an  original  compound  prescription,  to  suit  a 
special  condition,  calls  for  the  exercise  of  as  much  and  as  varied  ability 
as  does  almost  any  function  that  pertains  to  the  physician's  duties. 
After  the  prescriber  comes  to  a  point  in  experience  when  his  remedies 
are  familiar  and  his  own  combinations  of  them  are  established,  their 
prescription  by  him  in  any  modification  to  suit  special  cases  is  com- 
paratively easy;  but  to  the  beginner  in  practice,  nothing  is  much  more 
difficult  than  to  write  original  prescriptions  with  any  degree  of  con- 
fidence. 

The  art  of  prescribing  is  quite  ancient,  having  been  employed  first  by 
the  physician  to  guide  his  assistant  in  preparing  his  medicinal  mixtures, 
the  office  of  physician  haidng  included  also  that  of  apothecary.  Today, 
with  pharmacy  developed  into  a  distinct  profession,  our  prescriptions  are 
intended  to  direct  the  preparation  of  a  medicine  to  be  supplied  by  the 
pharmacist  to  the  patient,  to  be  used  according  to  the  'vsTitten  directions 
of  the  prescriber.  There  is  a  marked  contrast  between  ancient  and 
modern  prescriptions,  in  respect  to  their  definiteness  and  simplicity. 
Reference  to  the  works  of  Fallopius,  who  lived  1523-1562,  furnishes  an 
illustration  of  complexity  in  prescribing,  in  a  formula  written  by  him, 
which  contains  thirty-two  different  ingredients. 

Since  the  sixteenth  century  we  have  learned  enough  about  the  human 
body  and  its  diseases  to  know  that  it  is  unnecessary  to  exhaust  our 
materia  medica  in  prescribing  for  any  one  disease,  and,  with  a  more 


262  PRESCRIPTION   WRITING 

definite  knowledge  of  the  action  and  effects  of  drugs,  we  find  that  only 
a  few  agents  can  be  employed  to  real  profit  in  meeting  a  pathologic  con- 
dition. Hence,  our  prescriptions  of  today  approach  the  extreme  of 
simplicity,  usually  containing  not  more  than  three  or  four  ingredients. 
The  term  "shotgun"  prescription  is  derisively  applied  now^  to  a  formula 
containing  a  large  number  of  substances,  upon  the  supposition  that  it  is 
expected  to  hit  somewhere.  A  certain  idea  of  definiteness,  however,  is 
traced  back  to  Asclepiades  (about  100  B.C.),  who  is  credited  with  for- 
mulating the  object  of  treatment  to  be  to  cure  quickly,  safely  and 
pleasantly  (curare  cito,  tide  et  jucunde),  and  this  has  led  to  a  recognition 
of  the  typical  formula  as  consisting  of  four  ingredients,  each  related  to 
this  object  and  named  accordingly. 

1st  ingredient — Basis  or  base.  Cure. 

2d    ingredient — Adjuvant  or  auxiliary.     Quickly. 
3d    ingredient — C'orrigent  or  corrective.   Safely. 
4th  ingredient — Excipient  or  vehicle.         Pleasantly. 

While  these  terms  aid  us  in  comprehending  the  full  purpose  of  pre- 
scription writing,  it  must  be  understood  that  a  formula  need  not  contain 
more  than  one  active  agent,  and  that  any  combination  of  medicines 
should  always  be  based  upon  definite  objects  to  be  attained,  either  as  to 
form  or  utility. 

Several  definitions  are  here  necessary  to  the  proper  understanding  of 
terms : 

A  formula  consists  of  the  names  and  quantities  of  ingredients  that  are  to 
enter  into  a  medicinal  preparation,  wath  directions  for  compounding  them. 

An  official  formula  is  one  that  is  contained  in  the  United  States  Phar- 
macopceia. 

An  extemporaneous  formula  is  one  that  is  made  up  by  the  prescriber 
for  the  occasion. 

A  formula  may  be  simple,  containing  only  one  medicinal  agent,  or 
compound,  containing  two  or  more  active  ingredients. 

A  prescription  consists  of  the  formula  for  the  preparation  of  a  medi- 
cine, to  which  is  added  the  directions  for  its  use  in  a  given  case. 

Whenever  a  prescription  orders  an  official  formula,  only  the  title  of 
the  latter  need  be  given,  without  naming  the  ingredients.  Thus,  Dover's 
powder  (containing  opium  1  part,  ipecacuanha  1  part,  and  sugar  of  milk 
8  parts)  is  official  under  the  title  Pulvis  Ipecacuanhse  et  Opii.  In  pre- 
scribing, therefore,  it  is  only  necessary  to  write — 

I|. — Pulveris  Ipecacuanhse  et  Opii  (quantity), 


SELECTION  OF  INGREDIENTS  263 

instead  of  naming  each  ingredient  and  its  quantity,  as  would  be  necessary 
if  it  were  not  official. 

A  pharmacopoeia  is  a  book  of  national  authority,  containing  a  list  of 
recognized  drugs  and  preparations,  with  their  descriptions,  tests  and 
formulas.  It  is  the  authoritative  standard  for  the  purity  and  strength 
of  drugs  and  for  uniformity  of  preparations.  It  may  give  the  average 
dose  of  each  internal  remedy,  but  it  includes  nothing  of  the  actions  and 
uses  of  drugs.  While  in  most  countries  the  pharmacopoeias  are  under 
governmental  control,  the  United  States  Pharmacopoeia  is  under  the 
control  of  the  professions  of  medicine  and  pharmacy,  and  is  revised  by 
their  direction  every  ten  years. 

The  points  involved  in  making  a  compound  prescription  are: 

(a)  Selection  of  the  drugs  to  be  employed. 

(b)  Their  solubility  (unless  powder  form  is  desired). 

(c)  Their  compatibility  in  the  desired  combination. 

(d)  Their  dose. 

These  points  will  be  considered  separately. 

SELECTION  OF  INGREDIENTS. 

Selection  of  drugs  must  depend  primarily  upon  a  knowledge  of  the 
conditions  to  be  treated  and  acquaintance  with  the  power  of  drugs  to 
remedy  the  same,  and  secondarily  upon  the  practicability  of  their  adminis- 
tration or  their  combination  with  other  necessary  ingredients.  Some 
drugs,  by  reason  of  their  chemical  properties,  must  always  be  given 
alone;  others  cannot  be  brought  into  solution;  others  are  poisonous. 

Under  this  heading  the  main  objects  of  combining  medicines  may  be 
stated  as  follows: 

1.  To  secure  the  combined  effects  of  similarly  acting  medicines — e.  g., 

strychnine,  as  a  bitter  tonic,  may  be  combined  with  iron  as  a 
general  restorative  tonic. 

2.  To  secure  the  effects  of  medicines  that  have  distinct  and  unrelated 

actions — e.  g.,  in  the  official  Pilulse  aloes  et  ferri,  the  aloes  is 
a  cathartic  and  the  iron  a  restorative  to  the  blood. 

3.  To  secure  the  opposite  effects  of  medicines. 

(a)  By  correcting  or  modifying  the  action  of  the  base,  as  when  tincture  of 
aconite  is  added  to  tincture  of  iodine  to  render  its  action  milder. 

(b)  By  rendering  the  action  of  the  base  safer.  Here  antagonism  of  drug 
actions  is  made  use  of,  as  in  the  common  addition  of  atropine  to 
morphine  in  order  to  counteract  its  depressant  action  upon  the 
respiratory  center. 


264  PRESCRIPTION   WRITING 

4.  To  secure  a  suitable  form. 

(a)  By  the  use  of  special  solvents  to  obtain  a  liquid  form  of  an  other- 
wise insoluble  substance — e.  g.,  salicylic  acid  requires  460  parts 
of  water  to  dissolve  it,  but  if  borax  is  first  dissolved  to  saturation 
salicylic  acid  is  soluble  in  less  than  100  parts  of  the  solution. 

(fe)  By  securing  a  finely  divided  state  of  the  drug.  Sugar  of  milk  is 
often  used,  on  account  of  the  hardness  of  its  crystals,  to  rub  up 
other  drugs  into  very  fine  particles,  as  in  tablet  triturates. 

(c)  By  obtaining  a  inixture  that  is  agreeable  to  the  sight  and  -pleasant 
to  the  taste. 

5.  To  obtain  a  combination  to  act  as  a  new  substance. 

(a)  By  simple  mixture.  Dover's  powder  contains  opimn  and  ipecacu- 
anha, the  combination  having  a  diaphoretic  effect  not  possessed 
to  any  degree  by  the  separate  drugs. 

(6)  By  chemioal  action.  Chemicals  are  sometimes  combined  in  order 
to  obtain  a  new  definite  compound  by  their  reaction. 

6.  For  preservation  of  the  medicine. 

Alcohol,  glycerin,  or  sugar  in  large  quantity,  may  serve  not  only 

as  excipients,  but  also  to  preserve  medicinal  preparations  which 

are  to  be  kept  for  some  time.    It  is  not  considered  good  pharmacy 

to  add  antiseptics  to  medicines. 

Sugar  in  dilute  solution  will  ferment  easily  at  a  summer  temperature, 

but  when  used  in  strong  solution  (70  to  85  per  cent.),  as  in  some  of  the 

official  syrups,  it  will  preserve  the  preparation  indefinitely. 

Knowing  what  substances  we  wish  to  combine,  the  form  of  the  com- 
bination must  be  determined,  whether  powder,  pill,  capsule,  or  liquid. 
For  the  first  three  the  quality  of  solubility  is  unimportant,  but  when  the 
medicine  is  to  be  in  liquid  form,  solution  must  be  secured  whenever  it  is 
possible. 

SOLUBILITY. 

The  prescriber  should  familiarize  himself  with  the  solubility  of  each 
of  the  solid  substances  that  he  is  likely  to  use,  for  the  reason  that  no  rule 
of  solubility  can  be  laid  down.  A  few  general  statements,  however,  may 
serve  some  purpose. 

It  is  found  that  salts  are  usually  more  soluble  in  water  than  in  alcohol. 

Substances  that  are  soluble  in  water  are  quite  likely  to  be  soluble  in 
glycerin. 

Gums  and  mucilages  are  soluble  in  water,  but  insoluble  in  alcohol. 

Resins  and  resinous  substances  are  soluble  in  alcohol,  but  insoluble  in 
water. 


SOLUBILITY  265 

Substances  that  are  soluble  in  alcohol  are  generally  soluble  also  in 
ether,  chloroform  and  benzin. 

Water  stands  as  the  most  universal  solvent  and  vehicle  in  medicinal 
combinations. 

Alcohol  is  most  valuable  in  preparations  that  are  to  be  kept,  because 
of  its  preservative  power  in  addition  to  being  an  excellent  solvent. 

Glycerin  has  solvent  powers  similar  to  those  of  water,  and  it  is  also  a 
good  preservative. 

With  some  drugs  it  is  necessary  to  add  an  acid,  and  with  others  an 
alkali,  to  aid  solution — e.  g.,  borax  will  aid  solubility  in  water  of  both 
benzoic  and  salicylic  acids;  on  the  other  hand,  quinine  sulphate  has  its 
solubility  in  water  increased  by  the  addition  of  sulphuric  acid. 

A  number  of  substances  can  be  conveniently  handled  in  saturated 
solution,  some  to  be  used  in  full  strength,  others  requiring  dilution.  The 
following  table  furnishes  the  degree  of  solubility,  and  also  the  approx- 
imate percentage  strength  of  saturated  aqueous  solutions,  of  a  number 
of  the  most  commonly  used  substances :  [For  solubility  of  other  agents, 
see  Index  of  Drugs.] 

Percentage  strength 
Soluble  in  parts  of  saturated 

of  water.  solution. 

Acid,  benzoic 275                        0.36  per  cent. 

Acid,  boric 18                        5.5  " 

Acid,  carbolic  (phenol)       .      .•     .      .     15  to  20                         5  " 

Acid,  salicylic 460                        0.22  " 

Acid,  tannic 0..34*  300  " 

Alum 9  11  " 

Ammonium  carbonate 4  25  " 

Ammonium  chloride 2.6  40  " 

AntipjTine 1  100  " 

Betanaphtol 1000                       0.1  " 

^  4t  25  " 

Caffeine,  citrated 1  „_ 

I         2o  4  " 

Caffeine  sodiobenzoate 1.1  90  " 

Calcium  chloride 1.2  83  " 

Chloroform 200  0.5  " 

Cocaine  hydrochloride 0.4  250  " 

Codeine  phosphate 2.3  45  " 

Copper  sulphate 2.5  40  " 

Corrosive  sublimate 13.5  7.4  " 

Creosote 140  0.71  " 

Iodine 3000J 

*  U.  S.  P.,  1900. 

t  Citrated  caffeine  with  about  4  parts  of  hot  water  forms  a  clear,  syrupy  solution 
which,  when  diluted,  deposits  caffeine,  which  redissolves  with  25  parts  of  water. 

X  The  solubihty  of  iodine  is  increased  by  the  addition  of  potassium  iodide,  as  in 
Lugol's  solution  and  in  the  tincture. 


266 


PRESCRIPTION   WRITING 


Soluble  in  parts 
of  water. 


Lead  acetate 
Magnesium  oxide    . 
Magnesium  svdphate     . 
Morphine  sulphate 
Potassium  bicarbonate 


1.4 
15* 

1 
15.5 

3 


Potassium  bitartrate 155 


Potassium  bromide 
Potassium  carbonate    . 
Potassium  chlorate 
Potassium  iodide     . 
Potassium  nitrate    . 
Potassium  permanganate 
Potassium  sulphate 
Quinine  bisulphate 


...  1.5 

...  0.9 

.      .      .  11.5 

...  0.7 

...  2.8 

.      .      .  13.5 

...  9 

...  9 

Quinine  sulphate 725 

Resorcinol 0.9 

Saccharine  (benzosulphinide)        .      .      .  290 

Silver  nitrate 0.4 

Sodium  benzoate 1-8 

Sodium  bicarbonate 10 

Sodium  borate 15 

Sodium  bromide 1-1 

Sodium  chloride 2.8 

Sodium  thiosulphate  (hyposulphite)        .  0.5 

Sodium  saUcylate 0.9 

Strychnine  sulphate 32 

Sugar 0.5 

Thymol 1000 

Zinc  acetate 2.3 

Zinc  chloride 0.25 

Zinc  sulphate 0.6 


Percentage  strength 

of  saturated 

solution. 

70        per  cent. 


100 

6.5 
33 
0.65 
66 
110 

8.7 

143 

36 

7.4 

11 

11 

0.14 
110 

0.35 

250 

55 

10 

6.6 

90 

36 

200 

110 

3.1 

200 

0.1 

43 

400 

166 


The  following  table  is  of  convenience  in  preparing  any  solution  of  a 
desired  percentage  strength.  Quantities  are  expressed  in  the  old  system 
of  measures,  with  metric  equivalents  also  given.  The  result  is  not 
absolutely  exact,  but  sufficiently  so  for  practical  purposes: 


Amount  of  solution 
wanted. 


Quantity  of  drug  needed  for 


i%  strength.      1%  strength.       2%  strength.       5%  strength.      10%  strength 


1   fluidrachm 

(4  c.c). 

1  fluidounce 
(30  c.c). 

1  pint 
(500  c.c). 


iV  gram 
(0.02  gm.). 

2 I  grains 
(0.15  gm.) 

40  grains 
(2.5  gm.). 


4  grain 
(0;04gm.). 

5  grains 
(0..30  gm.). 

80  grains 
(5  gm.). 


1^  grains 
(0.08  gm.). 

10  grains 
(0.60  gm.). 

25  drachms 
(10  gm.). 


3  grains 
(0.20  gm.). 

24  grains 
(1.50  gm.). 

6  J    drachms 
(25  gm.). 


6  grains 
(0.40  gm.). 

48  grains 
(3  gm.). 

12^  drachms 
(50  gm.). 


*  With  15  parts  water  magnesia  does  not  dissolve,  but  forms  the  gelatinous  milk 
of  magnesia. 


INCOMPATIBILITY  267 

To  illustrate:  suppose  a  fluidounce  (30  c.c.)  of  a  2  per  cent,  solution 
of  cocaine  hydrochloride  is  wanted.  Opposite  the  desired  quantity  in 
the  first  column  find  the  quantity  expressed  in  the  2  per  cent,  column, 
which  in  this  case  is  10  grauis  (0.60  gm.).  This  dissolved  in  the  fluid- 
oimce  of  water  will  make  the  desired  strength  of  solution. 

INCOMPATIBILITY. 

Unless  the  ingredients  of  a  prescription  are  compatible  with  each 
other  the  object  of  their  combination  may  be  lost,  for  a  reaction  may 
occiu-  between  two  drugs,  with  the  result  that  the  activity  of  each  is 
altered  or  destroyed.  Again,  such  reaction  may.  in  case  of  certain  sub- 
stances, produce  poisonous  compounds. 

Incompatibility  may  be  physical  or  chemical. 

Physical  Incompatibility  consists  of  (a)  alterations  in  conditions  of 
solubility  without  any  chemical  change,  and  also  (h)  pertains  to  the 
inability  of  certain  substances  to  mix  with  each  other,  as  oil  and  water. 

Examples  of  physical  incompatibility  are: 

1.  Gums  and  mucilaginous  substances  are  precipitated  from  aqueous 
solutions  by  alcohol  and  alcoholic  liquids — e.  g.,  syrup  of  acacia  with 
tincture  of  chloride  of  iron  will  precipitate  the  acacia. 

2.  Resinous  substances  are  precipitated  from  alcoholic  solutions  by 
water — e.  g.,  tinctiu-e  of  m\Trh  with  water  will  become  tiubid  from 
precipitation  of  resin. 

Chemical  Incompatibility  consists  in  chemical  reactions  between  sub- 
stances, whereby  their  nature  is  altered.    There  may  be: 

1.  Simple  chemical  change  without  any  ^"isible  result. 

2.  Simple  chemical  change  with  or  without  loss  of  medicinal  acti\"ity. 

3.  Precipitation  of  a  new  compound  that  is  insoluble. 

4.  Coagulation. 

5.  Formation  of  poisonous  compounds. 

6.  Formation  of  explosive  compounds. 

It  is  difficult  to  bring  aU  instances  of  chemical  incompatibility  under 
rtile;  and  the  knowledge  of  chemistry  necessary  to  predict  always  that 
incompatibility  will  or  will  not  occtu*,  is  not  a  common  possession.  In 
addition  to  the  more  important  incompatibilities  previously  given  in 
connection  with  the  individual  drugs,  there  are  given  below  some  general 
statements  that  will  serve  as  a  basis  for  study.  A  cardinal  rule  to  be 
observed  is  that  drugs  should  never  he  prescribed  with  their  chemical  tests, 
unless  a  chemical  reaction  is  desired. 


268  PRESCRIPTION  WRITING 

1.  Alkalies,  hydrates  and  carbonates  react  with  acids  and  acid  salts. 

2.  Alkalies,  hydrates  and  alkaline  carbonates  react  with  salts  of 
alkaloids.  If  the  latter  are  in  solution,  precipitation  of  the  pure  alkaloids 
occurs. 

3.  Solutions  of  tannic  acid  react  with  salts  of  copper,  iron,  lead  and 
mercury. 

4.  Solutions  of  tannic  acid  react  with  alkaloids  and  with  their  salts. 

5.  Acids  or  acid  salts  react  with  alkalies,  hydrates,  carbonates  and 
with  salts  of  glucosides. 

Other  common  incompatibilities  that  do  not  admit  of  classification 
include : 

The  reaction  of  certain  salts  with  each  other — e.  g.,  nitrate  of  silver 
with  any  chloride. 

Alcohol  and  chloral  hydrate. 

Antip,\Tine  and  spirit  of  nitrous  ether  (when  acid). 

Borax  and  solution  of  corrosive  sublimate. 

Carbolic  acid  (pure  or  saturated  aqueous  solution)  and  cocaine 
hydrochloride. 

Carbolic  acid  (pure  or  sat.  aq.  soln.)  and  antipyrine. 

Carbolic  acid  and  collodion. 

Glycerin  with  potassium  chlorate  and  tincture  of  chloride  of  iron. 

Iodine  (in  solution)  and  starch. 

Lime-water   with  calomel   or   corrosive   sublimate. 

Potassium  iodide  and  spirit  of  nitrous  ether  (if  acid). 

Potassium  permanganate  and  sulphur  (explode  when  triturated). 

Potassium  permanganate  and  glycerin,  s>Tup  or  other  liquids  con- 
taining organic  matter. 

Powerful  chemical  drugs  and  oxidizing  and  reducing  agents  should 
be  prescribed  alone.  It  would  be  well  to  avoid  combining  the  following 
with  other  substances:. 

Acids,  strong. 

Alkalies  and  their  hydrates. 

Arsenic. 

Mercuric  chloride. 

Potassium  chlorate. 

Potassium  permanganate. 

Silver  nitrate. 

Tannic  acid. 


ANTAGONISM  OF  DRUGS 


269 


It  should  be  noted  that  chemical  incompatibility  may  be  intentional, 
in  order  to  obtain  a  new  substance — e.  g.,in.  preparing  ferri  hydroxidum, 
magnesium  oxide  (alkaline)  and  solution  of  a  ferric  salt  (acid)  are  mixed, 
the  result  being  a  precipitate  of  the  hydroxide.  Also,  in  the  employ- 
ment of  chemical  antidotes  in  the  treatment  of  poisoning,  their  value 
is  based  upon  their  incompatibility  with  the  poison. 


ANTAGONISM  OF  DRUGS. 

The  term  therajjeutic  incompatibility  does  not  apply  to  the  combina- 
tion of  drugs,  but  to  their  action.  It  is  often  used  to  designate  what  is 
better  known  as  antagonism  of  drugs. 

We  recognize  and  employ  the  opposite  effects  of  drugs  to  the  extent- 
of  combining  them  in  order  to  guard  against  poisoning,  and  of  adminis- 
tering, in  case  of  poisoning,  a  drug  that  shall  counteract  or  antagonize 
the  toxic  action.  In  this  sense  we  speak  of  such  drug  as  a  physiologic 
antidote  to  the  poison.  But  while  we  thus  employ  antagonism  of  drugs 
to  good  purposes,  in  our  prescriptions  we  avoid  combinations  that  will 
neutralize  the  desired  effect  of  the  principal  drug  or  drugs,  unless  a 
corrective  action  is  needed,  as  when  belladonna  or  a  volatile  oil  is 
added  to  a  strong  cathartic  drug  to  prevent  griping. 

Antagonism  of  drugs  can  seldom  be  absolute — i.  e.,  there  are  very  few 
drugs  whose  effects  exactly  neutralize  the  effects  of  other  drugs.  In 
cocaine  poisoning  we  find  that  two  drugs,  at  least,  are  needed  to  fully 
cover  the  depressant  action  of  the  poison.  (Plate  IV.)  Antagonism, 
therefore,  is  usually  only  partial,  but  it  still  may  meet  the  most  serious 
sjinptom  in  a  case.  Thus  in  poisoning  by  morphine  the  most  dangerous 
condition  is  that  of  paralysis  of  the  respiratory  center.  Strychnine  will 
antagonize  this  condition,  though  it  has  almost  no  influence  upon  the 
narcosis. 

Among  the  medicines  discussed  in  this  treatise  the  most  positive 
antagonistic  relations  are  the  following: 


Drug. 

Aconite 

Atropine 


Bromides  ) 
Chloral      / 


Antagonist 
'  Atropine 
Nitrites    . 
Caffeine  . 
Digitalis  . 

Aconite  . 
Digitalis  . 
Morphine 

Caffeine  . 
Atropine 
Digitalis  . 
Strychnine 


Site  of  antagonism. 

Vagus  nerve. 
Vagus  nerve. 
Heart. 
Heart. 

Vagiis  nerve. 
Vagus  nerve. 
Respiratory  center,  cerebrum. 

Brain,  circulation. 

Brain,  circulation. 

Heart. 

Medulla,  spinal  cord. 


270 


PRESCRIPTION   WRITING 


Drug. 

Caffeine 

Chloroform 

Cocaine 

Digitalis 

Ether 
Morphine 

Nitrites 
Strychnine 


Antagonist. 

f  Aconite    . 

I  Bromides,  chloral 

I  Morphine 

[  Anesthetics   . 

f  Caffeine  . 
\  Strychnine 
[  DigitaUs  . 

f  Atropine 
I  Caffeine  . 
j  Strychnine 
[  DigitaUs  . 

Aconite    . 
Atropine 
Bromides,  chloral 
Chloroform   . 
Cocaine   . 
Nitrites    . 

I  Caffeine  . 
\  Strychnine    . 

f  Atropine 
]  Caffeine  . 
[  Strychnine    . 

'  Aconite    . 
Atropine 
Caffeine  . 
DigitaUs  . 
Ergot 
Strychnine    . 

'  Bromides,  chloral 
Chloroform   . 
Ether       .      .      . 
Morphine 
Nitrites    . 


Site  of  antagonism. 

Heart. 

Brain,  heart. 

Brain,  respiratory  center. 

Brain,  respiratory  center,  heart. 

Cerebrum,  respiratory  center,  heart. 
Heart,  respiratory  center,  spinal  cord. 
Heart,  vasomotor  system. 

Cerebrum,  respiratory  center,  heart. 
Cerebrum,  respiratory  center,  heart. 
Respiratory  center,  heart,  spinal  cord. 
Heart. 

Heart. 

Vagus  nerve. 

Heart. 

Heart,  vasomotor  system. 

Heart. 

Vagus  center,  vasomotor  system. 

Cerebrum,  respiratory  center. 
Respiratory  center,  spinal  cord. 

Cerebrum,  respiratory  center. 
Cerebrum,  respiratory  center. 
Respiratory  center,  other  reflex  centers. 

Vagus  nerve. 

Vasomotor  system. 

Vasomotor  system. 

Vagus  center,  vasomotor  system. 

Vasomotor  system. 

Vasomotor  system. 

Medulla,  spinal  cord. 
Heart,  respiratory  center,  spinal  cord. 
Respiratory  center,  spinal  cord. 
Respiratory  center,  other  reflex  centers. 
Vasomotor  system. 


Antagonism  of  local  remedies  depends  chiefly  upon  their  chemical 
qualities,  the  action  being  usually  an  antidotal  one,  as  when  an  acid  is 
neutralized  by  an  alkali,  or  silver  nitrate  by  sodium  chloride.  This  part 
of  the  subject  is  treated  whenever  necessary  in  connection  with  the 
various  local  remedies.  (For  chemical  antidotes,  see  Table  of  Poisons 
and  Antidotes.) 

DOSES. 

Posology,  or  the  science  of  dosage,  constitutes  an  important  part  of 
our  knowledge  of  drugs.  Whether  we  use  few  or  many  substances, 
safety  requires  us  to  know  concerning  each,  what  quantity  may  be 
expected  to  produce  a  certain  desired  effect  and  also  what  quantity  must 
not  be  exceeded  when  it  is  necessary  to  secure  its  full  physiologic  influence. 
Conditions  in  disease  vary  so  greatly,  and  the  individual  susceptibilities 
of  patients  are  so  uncertain,  that  we  must  regard  the  statement  of  a 
single  definite  quantity  for  a  dose  as  being  somewhat  arbitrary.  There- 
fore, it  is  advisable  to  know,  not  a  single  quantity,  but  a  range  which 


THE  PRESCRIPTION  271 

shall  include  the  mmimimi  and  the  maximum  of  ordinary  dosage.  Idio- 
syncrasy forbids  the  use  of  certain  drugs  with  certain  individuals.  It 
also  modifies  the  action  of  the  drug  in  some  cases.  Tolerance  for  certain 
drugs,  particularly  morphine,  may  be  established,  so  that  those  who  take 
it  habitually  frequently  come  to  use  doses  many  times  greater  than  the 
ordinary  poisonous  dose.  The  mode  of  administration,  whether  by 
stomach  or  hjTJodermically,  wUl  modify  dosage.  (See  chapter  on  Admin- 
istration of  ^Medicines.)  After  all,  the  dose  of  a  drug  is  a  relative 
quantity,  which  reciuires  to  be  varied,  according  to  conditions,  within 
a  certain  range  of  efficiency  and  safety.  The  doses  of  the  principal 
drugs,  or  of  one  or  two  preparations  of  each,  which  represent  them  fully, 
should  be  learned. 

Dosage  for  Children. — The  doses  usually  given  in  text-books  and  tables 
are  for  adults.  For  children  only  a  fractional  quantity,  proportional  to 
the  age,  may  be  used.  The  simplest  rule  for  the  calculation  of  a  child's 
dose  is  that  kno^\Ti  as  Coiding's  Rule,  which  is:  Divide  the  age  of  the 
child  at  its  next  birthday  by  24,    Thus  a  child  three  years  old  wiU  have 

2"4  or  I  of  the  adult  dose.    Young's  rule,  which  divides  the  child's  age  by 

3 
the  age  +  12,  gives  a  slightly  larger  fraction;  thus  t — 7^=5-  In  con- 
nection with  such  rules  it  must  be  borne  in  mind  that  children  are  very 
susceptible  to  the  action  of  opium  and  morphine;  therefore,  these  drugs, 
always  to  be  avoided  ■^■ith  children  if  possible,  may  only  be  gi^'en  in 
much  smaller  quantity  than  the  proportional  dose  by  rule. 

THE  PRESCRIPTION. 

A  proper  prescription  always  consists  of  five  parts: 

1.  The  heading. 

2.  Names  and  quantities  of  ingredients. 

3.  Directions  to  the  compounder. 

4.  Directions  to  the  patient. 

5.  Date  and  signatiu-e. 
These  will  be  considered  in  order: 

1.  The  Heading. — Anciently  the  prescription  was  begun  with  a  prayer 
to  Jupiter  or  other  heathen  deity.  Later  this  was  shortened  to  the  simple 
sign  of  Jupiter  (1^) .  With  an  upright  stroke  before  it  we  have  a  resem- 
blance to  the  sign  I^,  which  we  use  today.  To  us  this  sign  really  means: 
"Take,"  being  an  abbreviation  of  the  imperative  form  recipe  of  the 
Latin  verb  recipio — to  take. 


272  PRESCRIPTION   WRITING 

2.  Names  and  Quantities  of  Ingredients. — ^The  names  are  usually 
written  in  Latin,  for  the  reasons  that  this  is  not  subject  to  the  changes 
of  a  modern  language  and,  being  a  universal  language  of  science,  it  is 
known  the  world  over.  A  formula  in  Latm,  therefore,  can  be  read 
anywhere  in  the  world  of  science  today,  and  doubtless  will  be  just  as 
current  one  hundred  years  hence  as  now. 

The  quantities  are  expressed  either  in  the  terms  of  apothecaries' 
weight  and  corresponding  liquid  measure,  or  in  terms  of  the  metric 
system.  The  latter  has  the  advantage  of  simplicity  in  being  a  decimal 
system.  Calculation  by  it  is  easier,  and  there  is  less  danger  of  error, 
because  the  position  of  a  figure  denotes  its  value,  and  not  an  added  sign 
that  may  be  poorly  written. 

3.  Directions  to  the  Compounder. — In  most  cases  the  precise  mode  or 
detail  of  compounding  is  better  left  to  the  dispenser,  who  is  trained  in 
that  art,  and  the  simple  abbreviation  ]M.,  which  stands  for  the  Latin 
imperative  misce,  meaning  "mix,"  is  sufficient.  Only  when  the  pre- 
scriber  has  special  directions  to  give,  or  when  directing  the  number  of 
pills  or  powders  into  which  a  mixture  is  to  be  divided,  need  he  write  out 
his  directions  in  full.  Li  such  case  Latin  may  be  used,  but  plain  English 
is  preferable,  unless  the  prescription  is  likely  to  go  to  a  foreign  country. 

4.  Directions  to  the  Patient. — This  part  added  to  a  formula  makes  of 
it  a  prescription.  It  is  begun  with  the  abbreviation  Sig.  (or  S.),  which 
stands  for  the  Latin  signa,  meaning  "Write;"  and  whatever  is  directed 
should  follow  this  sign  and  be  written  without  abbreviation,  so  that 
it  may  be  copied  verbatim  upon  the  label.  Not  only  should  these  direc- 
tions be  written  out  in  full,  but  they  should  be  read  to  the  patient  or 
attendant,  in  order  to  guard  against  danger  through  a  possible  error 
in  copying.  The  directions  to  the  patient  must  state  how  the  medicine 
is  to  be  used — if  locally,  the  word  "  apply"  may  be  included ;  there  is  good 
reason  also  for  placing  immediately  after  the  "Sig."  the  term  "mouth- 
wash," "gargle,"  "ointment,"  "wash,"  or  whatever  will  best  designate 
the  nature  of  the  local  application  and  serve  to  guard  against  its  being 
taken  internally;  if  internally,  the  directions  must  include  dose  in  drops, 
teaspoonfuls,  etc.,  and  the  time  or  intervals  of  taking.  This  part  of  the 
prescription  must  be  very  explicit,  and  the  common  phrase  "use  as 
directed,"  with  only  verbal  directions  to  the  patient,  should  be  discarded. 

In  case  a  poisonous  application  is  ordered  it  is  well  to  add  the  word 
"Poison"  to  the  directions,  with,  however,  verbal  explanation  to  the 
patient  or  attendant  as  to  its  proper  use. 


THE   USE  OF  LATIN  IN  PRESCRIPTIONS  273 

5.  Date  and  Signature. — The  date  is  essential  for  reference,  and  the 
prescriber's  signature  for  authenticity.  It  is  common  practice,  however, 
to  use  printed  forms  which  have  the  prescriber's  name  and  address 
above  or  below  the  blank  space  reserved  for  the  prescription  proper, 
in  which  case  the  signature  is  often  omitted. 

The  name  or  initials  of  the  patient  should  be  added,  in  order  to  avoid 
the  use  of  the  wrong  medicine,  in  case  of  more  than  one  prescription 
being  filled  at  the  same  time  for  different  members  of  a  family. 

Sometimes  a  special  note  in  addition  to  all  the  above  will  be  advisable, 
as  when  quite  large  doses  of  a  drug  are  ordered;  the  statement  "large 
dose  intended,"  or  writing  out  the  quantity,  will  show  the  dispenser 
that  the  amount  ordered  is  correct. 

Again,  the  evil  of  repeating  prescriptions  by  unprofessional  phar- 
macists may  be  guarded  against  by  writing  prominently  upon  the 
prescription  the  words  "not  to  be  repeated." 

The  reference  above  to  improper  pharmacy  leads  the  author  to  express 
his  appreciation  of  the  professional  pharmacy  which  is  so  evident  today. 
The  knowledge  of  doses  that  the  pharmacist  is  required  to  possess  is  a 
safeguard  against  errors  of  dosage  in  prescriptions.  The  prescriber  is 
responsible  for  whatever  he  writes,  but  physicians  have  often  been  saved 
the  humiliation  of  discovered  error  in  prescribing,  or  the  results  that 
might  follow,  by  the  cooperation  of  the  pharmacist  in  calling  attention 
confidentially  to  the  same — a  kind  of  favor  too  often  unappreciated 
by  the  prescriber. 

THE  USE  OF  LATIN  IN  PRESCRIPTIONS. 

To  write  prescriptions  in  best  form  requires  some  knowledge  of  Latin, 
especially  of  the  declensions  of  nouns  and  adjectives,  but  not  more  than 
can  be  acquired  in  a  very  short  time  with  the  aid  of  a  Latin  grammar. 
To  one  not  sufficiently  familiar  with  the  language,  this  course  is  earnestly 
advised,  as  repaying  well  the  effort  that  is  necessary.*  As  a  means  of 
review,  and  in  order  to  emphasize  what  is  really  essential  to  our  purpose, 
a  brief  outline  of  the  essential  grammatic  forms  is  here  given,  without 
any  attempt  at  completeness.  Many  case-endings  are  never  used  in 
prescriptions,  and  are,  therefore,  omitted.  The  genitive  endings  are 
given  prominence  because  they  are  almost  invariably  employed. 

*  A  very  useful  aid  is  the  Latin  Grammar  of  Pharmacy  and  Medicine,  Robinson. 
P.  Blakiston's  Son  &  Co.,  Philadelphia. 
17 


274 


PRESCRIPTION    WRITING 


Declensions  of  Nouns  and  Adjectives. 


Nouns. 


1st  Declension. 
Fern. 


2d  Declension. 
Masc.  Neut. 


3d  Declension. 
Masc. 
and  Fem.     Neut. 


4th  Declension. 
Masc. 
and  Fem.     Neut. 


Singular.                   ' 

Nominative 

a  (e) 

Genitive 

ae  (es) 

Accusative 

am  (en) 

Ablative 

a  (e) 

Plural. 

Nominative 

ae 

Genitive 

arum 

Accusative 

as 

us  (os)  um  (on) 


um  (on) 


(various) 


Exceptions: 


(as  Nom.) 


um  (ium) 


Theobroma — tis,  Rhus — ois,  is  of 

and  Physostigma    |  the  3d  declension. 

— tis,  are  of  the  3d 

declension. 


The  4th  declension 
includes  only  four 
names  of  drugs: 

Cornus 

Fructus 

Quercus 

Spiritus 


Indeclinable: 


Amyl 
Buchu 
Catechu 
Elixir 


Gambir 
Kino 

Sassafras 


Alcohol  I  are  regarded  by 

Eucalyptol     >     some    authorities 
Menthol  J      as  indeclinable. 


Adjectives. 


1st  and  2d  Declension.    [  3d  Declension. 

i     Masc.  Neut. 


Fem.       Masc.       Neut. 


and  Fem. 


Singular: 

Nominative 

a 

us  (er) 

um 

is  (s) 

e  (s) 

Adjectives  of  other  ter- 
minations   and    plural 

Genitive 

ae 

i 

i 

is 

forms  are  very  seldom 
used    in    prescriptions. 

Accusative 

am 

um 

um 

em 

e  (s) 

The  rules  of  Latin  grammar  apply  as  to  relation  of  nouns,  adjectives, 
verbs  ancJ  other  parts  of  speech. 


WEIGHTS  AND  MEASURES  275 

Use  of  Cases. — The  nominative  case  is  never  used  in  a  prescription, 
as  the  sentence  is  ahvays  introduced  by  the  imperative  recipe,  the  sub- 
ject of  which  is  tJiou  understood.    The  complete  sentence  would  be: 

Take  thou  ]  of  a  substance  |  a  quantity.  ■ 
I       (genitive)       |  (accusative) 

The  genitive  case  of  the  name  of  ingredient  is  required  when  the 
quantity  is  expressed  by  a  noun,  as: 

Take  thou  |  of  a  substance  |    one  ounce. 
I       (genitive)       |  (accusative) 

The  accusative  case  of  the  name  of  the  ingredient  is  required  when 
the  quantity  is  expressed  by  a  simple  numeral  adjective,  as: 

Take  thou /owr  pills  =  I^.  Pilulas  iv. 

The  ablative  case  is  used  after  the  preposition  cum  (meaning  ivith),  as: 
I^. — Ferri  hydroxidi  cum  magnesii  oxido,  5j. 

Verbs. — The  few  verbs  employed  are  in  the  imperative  form  except 
where  the  directions  to  the  compounder  are  ^\Titten  in  Latin,  when  the 
passive  form  may  be  also  needed,  as: 

I^. — Massse  hydrargj'ri,  gr  xxx. 

Fiant  pilulae,  vj.     (Let  be  made  pills  six.) 

WEIGHTS  AND  MEASURES. 

The  system  of  weights  and  measm'es  most  approved  in  scientific 
circles  is  the  metric  system.  Being  a  decimal  sy.stem,  it  is  easily  mastered, 
and  no  student  in  any  department  of  medical  science  should  be  excused 
from  acquu'ing  a  practical  familiarity  with  its  use.  The  United  States 
Pharmacoiceia  employs  it  exclusively  in  the  expression  of  quantities  of 
ingredients. 

While  it  is  not  possible  to  discard  the  apothecaries'  system  entirely  at 
the  present  time,  because  of  the  large  number  of  practitioners  who  have 
used  it  for  years,  whenever  the  old  system  is  employed  its  denominations 
may  be  reduced  to  three,  as  follows: 

A  jyothecaries' .  Liquids. 

60  grains  (gr.)  =  1  drachm  (5)  60  minims  (Ttl)  =  1  fluidrachm  (fo) 

8  drachms  =  1  ounce  (§)  8  fluidrachms  =  1  fluidounce  (fg) 

The  use  of  the  scruple  3  (20  gr.)  often  leads  to  a  confusion  of  signs,  and  the 
pound  (16  oz.)  is  seldom  required  in  prescribing,  so  they  are  omitted. 


276 


PRESCRIPTION   WRITING 


The  Metric  System. — In  studying  the  metric  system  advantage  may 
be  taken  of  its  similiarity  to  our  American  system  of  money,  using  the 
latter  to  illustrate  the  former  in  a  very  simple  way,  as  appears  below. 
In  the  comparison  below,  the  decimal  point,  or  perpendicular  line,  is  the 
dividing  point  between  units  and  fractions: 


(y    °^    m 

I  Q  O  S 


United  States  money        10 


Metric  weight 


Grams 

10 


Metric  capacity 

Milliliter  or  Cu.  centimeter 
1 


CD   r^  -— 


1 

0  1 
0  0 


1 

0  1 
0  0   1 


Note. — In  practical  use  we 
disregard  the  term  decigram, 
much  as  we  do  the  term  dime, 
using  centigrams,  as  we  do  cents, 
for  any  fraction  of  the  unit;  but 
the  term  millioram,  is  much  used 
because  of  the  small  fractions 
which  so  many  doses  require. 


15.4  grains. 
1.5 

0.15      " 
0.015   " 


Approximately. 

15  grains. 

li      " 


16.23  minims. 
1.6 
0.16 
0.016      " 


Approximately. 
16  minims. 
U      " 


Equivalents  of  apothecaries'  weights  and  liquid  measures  in  grams 
and  cubic  centimeters  are : 


EXACTLY. 

Gm. 

APPROXIMATELY. 

Gm. 

EXACTLY. 

Gm. 

APPROXIMATELY. 

Gm. 

Tou  grain 

-id     " 

= 

.000648 
.00108 

.0006 
.001 

10   grains 
15 

= 

.6479 
.9717 

.60     or 
1. 

t'o        " 
\ 

= 

.00648 

.006 

15.43    " 

= 

1. 

1. 

= 

.0081 

.008 

20 

= 

1.296 

1.30 

1             " 

5 

= 

.0162 
.0324 

.015 
.03 

30 
1  Drachm 

: 

1.944 
3.888 

2. 
4. 

1  Grain 

3  grains 

4  " 

= 

.0648 
.1944 
.2592 

.06 
.20 
.25 

or 

.065 

2  drachms 
4 

1  Ounce 

= 

7.776 
15.551 
31.102 

8. 

15.50 
31. 

5      " 

= 

.3239 

.30 

WEIGHTS  AND  MEASURES 


Zi  i 


EXACTLY. 

APPEOXniATELT. 

EXACTLY. 

AFPEOXniAIELY. 

C.c. 

C.c. 

Cx. 

Cj:. 

1  Minim 

= 

.06161 

.06 

1  Fluidrachm  = 

3.696 

3.7 

-I  \f;riirrii 

= 

.24644: 

.25 

1  Fltiidotmce  = 

29.573 

30. 

PI  Afinim? 

= 

..30S0.5 

.30 

1  Pins-                   = 

473.179 

475.* 

10  Afinim? 

= 

.6161 

.60 

1  Quart               = 

946.35S 

950.* 

lo  Afinim? 

= 

.924       ■ 

1. 

1  GaUoQ             = 

3785.432 

3800. 

16.23  Minim- 

= 

1. 

1. 

=. — A?=:=.CX1M-IT£LY    4-  1 


'  APPBOXilMATEL.Y%  IN;- 


1  LITER 

CONTAINS  1000  MILULITERS 
OR  CUBIC  CENTIMETERS 

HOLDS  1    KILOGRAM  OF  DISTILLED 
WATER  AT  4-'='C. 

EQUIVALENT  OF  2.11   PINTS 


MEASURES  ta.23  MINIMS 


Fig.  15. — Diagram  shomag:  1.  The  capacity  of  1  Hter  with  its  equivalents.  2. 
Linear  measures — decimeter  and  centimeter,  with  equivalents.  3.  The  cubic  centi- 
meter or  mLUiHter,  and  gram,  with  equivalents.    (Slightly  reduced  in  size.) 


The  several  units  of  the  metric  system  are: 

Unit  of  length:  ]»kleter  =  0ne  forty-miUionth  part  of  the  earth's 
meridian  ^39.37  inches). 

Unit  of  capacity:    Liter  =  One  cubic  decuneter  (1.05  quarts). 

Unit  of  weight:  Gram  =  Weight  of  one  Cuhic  centimeter  or  Milliliter  of 
distilled  water  at  4°  C,  the  pomt  of  greatest  density  of  water  (15.4  grams) . 

Following  are  given  the  exact  and  approximate  equivalents  of  the 
metric  measures  of  length,  capacity  and  weight. 

*  For  ordinary  purposes  .500  c.c.  is  the  convenient  approximate  equivalent  of  a 
pint  and  1000  c.c.  of  a  quart. 


278 


PRESCRIPTIOX   WRITIXG 


LENGTH. 

EXACT  EQCIVALEIO-S. 

.03937079  inch Millimeter,  .001 

.3937079  inch Centimeter,  .01 

3.937079  inches Decimeter,  .1 

39.37079  inches Meter,  1. 

32  feet  9.7079  inches Dekameter,  10. 

328  feet  1.079  inches    .             Hektometer,  100. 

3280  feet  10.79  inches         .      .                   .      .  Kilometer,  1000. 

6.213824  miles Mj-riameter,  10000. 


APPRO.XIMATE  EQUIVALENTS. 

■}s  of  an  inch. 
i  of  an  inch. 
4  inches. 
3  feet  3  inches. 
2  rods. 
20  rods, 
f  of  a  mile. 
6t  miles. 


EXACT    EQUIV.VLEN'TS. 


Liquid. 
.2705624  f5 
.338158  f5 
.845395  gi. 
1.0567454  qts. 
2.64186  gal. 
26.4186  gal. 
264.186  gal. 
2641.86  gal. 


Dry. 
.06102705  cu.  in. 
.6102705  cu.  in. 
6.102705  cu.  in. 

.90813  qt. 

1.13516  pks. 

2.8379  bu.    . 

1.30802  cu.  yds. 

13.0802  cu.  yds. 


CAPACITY. 

Millihter, 

Centiliter, 

Deciliter, 

Liter, 

Dekaliter, 

Hektoliter, 

Kiloliter, 

MvTialiter, 


APPROXIMATE    EQUIVALENTS. 


.001 

.01 

.1 


1. 

10. 

100. 

1000. 

10000. 


Liquid. 

Dry. 

16  m 

.06  cu.  in 

2.7  f5 

.6  cu.  in. 

3.3  f5 

6  cu.  in. 

Iqt. 

.9  qt. 

2 . 5  gal. 

1  pk. 

26  gal. 

2.8  bu. 

8.3  bbls. 

35  cu.  ft. 

84  bbls. 

13  cu.  yds. 

EXACT    EQUIVALEXT.S.  WEIGHT. 

Avoirdupois.  Troy. 

.01543234874  grain        .  MUligram,  .001 

.1543234874  grain    .      .  Centigram,  .01 

1.543234874  grains     .      .  Decigram,  .1 

15.43234874  grains       .      .  Gram,  1. 

5.6438304  drs.       2.572  5 Dekagram,  10. 

3.5274  oz.                3.215  3 Hektogram,  100. 

.2.2046  lbs.              2.679  lbs Kilogram,  1000. 

22.046  lbs.              26.79  lbs M\Tiagram,  10000. 


APPROXIMATE  EQUIVALENTS. 


Avoirdupois 

Troy. 

6^0  grain. 

5  grain. 

1.5  grains 

15  grains. 

.      5.6  drs. 

2.5  3 

3.5  oz. 

35 

.      2.2  lbs. 

2.6  lbs. 

.   22  lbs. 

26  lbs. 

^Metric  eqiii\'alents  of  our  common  linear  measures  are: 


Meters. 

E.XACTLY. 

APPROXI.MATELT 

i  Inch 

= 

.00635     or       6.35  Millimeters. 

6i  Millimeters. 

I  Inch 

= 

.01905 

'        19.05 

19 

llnch 

= 

.0254 

'      2.54  Centimeters 

2j  Centimeters. 

6  Inches 

= 

.1524 

'      15.24 

15 

10  Inches 

= 

.2540 

'     25.40 

25 

IFoot 

= 

.3048 

'    30.48  Centimeters 

30i 

1  Yard 

= 

.91439 

'     91.439 

90 

1  Rod 

= 

5.02914 

'        5.02914  Meters. 

5  Meters. 

1  MUe 

= 

1609.3264 

'        1.6093264  Kilometers. 

1.6  Kilometers. 

While  the  gram  is  a  measure  of  weight  and  the  mUUliter  of  capacity, 
liquids  may  be  weighed  and  expressed  in  grams.  But  the  U.  S.  P. 
weighs  solids  and  measures  liquids  in  its  formulas.  To  avoid  confusion 
in  prescribing,  we  specify  both  grams  and  milliliters  in  our  prescription 
forms: 


B 


Cm.  or  mil. 


WEIGHTS  AND  MEASURES  279 

Thus  whole  numbers  (to  left  of  line)  will  be  read  as  grams  if  they 
represent  solids  and  as  milliliters  if  liquids,  while  decimal  quantities 
will  be  read  as  centigrams  and  milligrams  in  either  case,  as  the  difference 
between  the  measure  and  weight  of  so  small  quantities  is  very  slight. 

Rules  for  Converting  Quantities  to  Metric  Terms: 

1.  If  in  grains  (or  minims),  multiply  the  number  by  0.065  (fluids  0.06) 
or  divide  by  15  (fluids  16).  The  result  will  express  the  quantity  in 
grams  or  decimal  of  a  gram. 

2.  If  in  drachms,  multiply  the  number  by  4  (fluids  3.70).  The 
product  will  express  the  quantity  in  grams. 

3.  If  in  ounces,  multiply  the  number  by  31  (fluids  30).  The  product 
will  express  the  quantity  in  grams. 

Rules  for  Converting  Quantities  from  Metric  Terms: 

1.  Divide  grams  by  0.065  (fluids  0.06)  or  multiply  by  15  (fluids  16). 
The  result  will  be  in  grains  (or  minims). 

2.  Divide  grams  by  4  (fluids  3.70).    The  result  will  be  in  drachms. 

3.  Divide  grams  by  31  (fluids  30).    The  result  will  be  in  ounces. 

In  learning  doses  in  metric  terms,  it  is  well  to  begin  with  convenient 
quantities  that  approximate  the  usual  dose;  thus: 

For  substances  with  a  minimum  dose  of  e'o'  of  a  grain,  adopt  0.001  gm. 
(1  milligram)  as  the  convenient  basis. 

For  substances  with  a  minimum  dose  of  1  grain,  adopt  0.05  gm. 
(5  centigrams)  as  the  starting-point. 

For  substances  having  the  minimum  dose  of  10  grains,  adopt  50  gm. 
(50  centigrams)   as  the  starting  point. 

For  larger  doses  adopt  grams  and  half -grams  as  nearly  as  possible. 

Rules  for  Use  of  the  Metric  System  in  Prescribing : 

The  difficulty  of  applying  the  metric  system  to  prescription  writing 
by  those  accustomed  to  think  in  the  old  system  is  very  largely  removed 
by  following  the  rule  given  below,  which  does  away  with  the  need  of 
calculating  total  quantities,  and  renders  prescribing  much  easier. 

As  there  are  between  fifteen  and  sixteen  grains  in  a  gram,  the  ordering 
of  fifteen  or  sixteen  doses  always  establishes  a  relation  between  the  two 
systems,  which  permits  us  to  apply  the  following  rule.* 

*  Long.     Medical  News,  Philadelphia,  March  25,  1893. 


280  PRESCRIPTION   WRITING 

1.  jNIake  the  whole  quantity  to  consist  of  sixteen  doses:  then — 

2.  The  number  that  represents  the  single  dose  of  an  ingredient  in 
grains  or  minims  will  express  the  required  quantity  of  that  ingredient 
in  grams  or  milliliters.     For  example: 

Gill,  or  mil. 

I^. — Potassii  bromidi  (single  dose  10  grains)    .      .      .      10 1 
Morphinae  sulphatis  (single  dose  J  grain)       .      .  1 25 

Spiritus  setheris  nitrosi  (single  dose  30  minims)        30  ] 
Aqua",  q.  s.  ad  (16  teaspoonful  doses)       .      .      .     60 1 

M.— Sig.,  etc. 

The  same  rule  applies  in  prescribing  powders  or  pills: 

Gm.  or  mil. 

I^. — Pulveris  ipecacuanha^  et  opii  (single  dose  5  grains)  5 
Pulveris  digitalis  (single  dose  1  grain)  ...  1 
Strychninae  sulphatis  (single  dose  -'o  grain)  .      .  02 

Misce  et  divide  in  chartulas  numero  x\'i. 

It  is  found  in  practice  that  sixteen  is  a  very  convenient  and  usually 
sufficient  number  of  doses  in  the  average  case,  or  until  the  treatment 
is  to  be  modified.  However,  when  one  has  mastered  the  application  of 
the  rule,  it  is  a  simple  matter  to  double  the  quantities  for  twice  the 
number  or  doses,  or  to  reduce  them  for  a  lesser  number. 

AYhile  this  rule  does  not  apply  in  making  solutions  without  definite 
dosage,  the  convenience  of  the  decimal  system  in  ordering  and  preparing 
percentage  solutions  is  apparent.  With  a  total  quantity  of  1000,  100,  or 
10  mils,  the  calculation  of  quantity  of  ingredients  is  very  simple. 

COMMON  MEASURES  AND  THEIR  EQUIVALENTS. 

In  the  fourth  part  of  a  prescription  (directions  to  the  patient),  the 
amount  to  be  taken  should  be  expressed  in  domestic  measures  as  far  as 
is  possible,  so  as  to  be  perfectly  plain  to  the  user.  The  use  of  the  measur- 
ing glass,  marked  for  quantities  to  correspond  to  the  common  measures  of 
teaspoon,  tablespoon,  etc.,  should  be  encouraged  in  the  interest  of  accu- 
racy; for  there  is  some  variation  in  size  of  teaspoons  as  there  are  grades 
of  fulness  to  the  spoon,  one  person  making  it  even  full  and  another  filling 
it  to  its  capacity,  which  may  mean  a  difference  of  fully  thirty  minims. 

The  common  practice  of  ordering  doses  in  so  many  drops  is  likewise 
inaccurate  unless  one  is  sure  of  the  size  of  the  drop  of  the  particular 
liquid  as  administered ;  for  there  is  a  great  difference  in  the  size  of  drops, 
dependent  not  only  upon  the  density  and  character  of  the  liquid  but  also 
upon  the  shape  of  the  opening  from  which  it  is  dropped.  For  example, 
in  dropping  water  from  the  mouth  of  an  ordinary  medicine  bottle  each 
drop  may  contain  1^  minims,  while  from  an  eye  dropper  the  drops  may 


ORDER  OF   WRITING  A   PRESCRIPTION  281 

not  measure  more  than  ^  minim,  varjdng  according  to  size  of  opening 
and  thickness  of  the  glass.  Drops  of  alcohol  are  approximately  one- 
half  the  size  of  drops  of  water  under  like  conditions,  while  drops  of  ether 
and  chloroform  are  still  smaller.     (See  below.) 

It  should  be  borne  in  mind,  therefore,  that  although  drops  of  aqueous 
solutions  approximate  minims  in  size,  drops  of  alcoholic  solutions,  as 
tinctures,  are  about  one-half  as  large  and  the  number  in  a  given  dose 
will  be  correspondingly  greater.  But  it  is  evident  that  the  purpose  of 
accurate  dosage  would  be  best  served  by  the  use  of  a  pipette,  marked  for 
minims,  in  measuring  out  small  doses. 

Tables  of  the  number  of  drops  in  a  fluidrachm  are  of  comparative 
rather  than  positive  value,  because  of  the  difference  in  size  of  drops  of 
the  same  liquid  under  different  conditions.  However,  it  is  well  to  re- 
member the  following  easily-learned  facts  in  regard  to  the  size  of  drops: 

Water,  aqueous  solutions  and  acids  have  about  60  drops  to  a  fluidrachm 
or  teaspoonful. 

Alcohol,  tinctures  and  spirits  have  about  100  to  120  drops  to  a 
fluidrachm. 

EtJier  and  chloroform  have  still  smaller  drops,  with  from  120  to  250 
to  a  fluidrachm. 

The  approximate  equivalents  of  common  measures  are: 

A  drop  (of  water) =1115- 

A  teaspoon =f51, 

A  dessertspoon =f52, 

A  tablespoon =fo4, 

A  wineglass =f§2, 

A  teacup '=fo4, 

A  tumbler =fo7, 

ORDER  OF  WRITING  A  PRESCRIPTION. 

It  is  well  to  follow  a  regular  order  in  writing  prescriptions  both  in  the 
interest  of  economy  of  time  and  thought  and  in  order  to  lessen  the  danger 
of  errors  by  omission.  Certain  parts  of  the  work  can  be  made^quite 
mechanical  including  the  use  of  a  prepared  form  of  blank  something 
like  the  following: 

A.  L.  Seek,  M.D. 
160  West  70th  Street, 
Hours:  2 — 4  New  York. 

Gm.  or  mil. 


1,  or 

0.0:3-0.06  gm. 

or 

4   mil. 

or 

8 

or 

15 

or 

60 

or 

120 

or 

200 

282  PRESCRIPTIOX   WRITIXG 

If  the  old  system  of  weights  and  measures  is  to  he  employed  this 
blank  will  omit  the  upright  line  and  the  abbreviations  above  it. 
The  order  usually  followed  in  writing  a  prescription  is  as  follows: 

1.  Decide  what  drugs  are  needed  and  select  the  preparation  of  each  to 
be  used;  then  write  the  names  of  all  ingredients,  as  below. 

Supposing  our  case  to  be  a  child  of  fi^'e  with  a  cough  that  is  spasmodic 
in  character,  we  may  wish  to  write: 

I^.— Potassii  bromidi, 

Tincturae  belladonnae, 

Spiritus  setheris  nitrosi, 

Aquse, 

Syrupi  lactuccarii, 

2.  Decide  upon  the  number  of  doses  and  bulk  of  each  dose,  by  which 
you  arrive  at  the  total  quantity  of  the  mixture.  For  a  child  of  five  the 
single  total  dose  may  well  be  a  teaspoonful  and  the  number  of  doses  16, 
which  gives  a  total  quantity  of  2  fluidounces  or  about  60  c.c. 

3.  ^lultiply  the  single  dose  of  each  ingredient  by  the  number  of  doses. 
Employing  Cowling's  rule  for  dosage  for  children:  "Divide  the  age  at 

next  birthday  by  24,"  we  obtain  2I  or  \  as  the  fraction  of  the  adult  dose 
to  be  used.  But  even  with  the  use  of  the  rule  we  must  exercise  dis- 
crimination. In  this  instance,  potassium  bromide  being  a  rather  harmless 
drug,  we  shall  want  a  full  dose  in  order  to  secure  its  depressant  effect 
upon  nerve  centers,  so  we  may  exceed  the  proportional  amount  of  the 
average  adult  dose.  Let  us  take  6  grains  (gm.  0.40)  as  the  dose.  Sixteen 
doses  will  give  us  96  grains  as  the  total  quantity,  or,  approximately  1| 
drachms  (gm.  6).  Of  tincture  of  belladonna  we  take  according  to  the 
rule  \  of  the  average  adult  dose,  ^  of  8  minims  X16  doses  =32  minims, 
or  approximately  \  fluidrachm  (mils  2). 

Of  spirit  of  nitrous  ether  we  take  \  of  30  minims  as  the  single  dose  or 
8  minims  (gm.  0.50).  Sixteen  times  this  will  give  us  approximately  2 
fluidrachms  (mils  8).  The  two  last  ingredients  are  vehicles,  water  being 
used  as  a  solvent  and  diluent  and  syrup  of  lactucarium  as  a  pleasant 
excipient  with  very  feeble  medicinal  power.  The  dose  of  these,  there- 
fore, is  unimportant.  Of  water  we  use  a  convenient  quantity  to  insure 
solution  of  the  potassium  salt,  say  \  fluidounce  (mils  15).  The  vehicle 
last  to  be  added  may  ha\e  its  quantity  definitely  expressed,  being  the 
difference  between  the  sum  of  other  liquids  in  the  mixture  and  the  total 
desired  bulk;  but  a  simpler  procedure  is  to  order  sufficient  of  the  vehicle 
to  be  added  to  make  up  the  total — (juantuvt  sufficit  (q.  s.)  ad  (up  to) 
fgij  (mils  60).     We  then  have 


COXSTRUCTIOX  OF  PRESCRIPTIONS  283 

Gm.  or  niiL 

I^. — Potassii  bromidi oiss  or  6| 

Tincturse  belladonnse    .      .            .      .      .      .     foss  "  2' 

Spiritus  setheris  nitrosi ^  foij  "  8 

Aquse ,.      .     foiv  "  15 

S\Tupi  lactucarii q.  s.  ad    fgij  "  60 

[In  arriving  at  the  above  quantities  in  metric  terms  we  may  apply 
the  simple  rule  for  the  use  of  the  metric  system  fp.  279.)] 

"Whenever  we  order  the  same  quantity  of  each  of  two  ingredients, 
we  may  use  the  abbreviation  aa,'  meaning  of  each.  Had  we  made  the 
quantity  of  water  in  the  above  the  same  as  that  of  the  spirit  of  nitrous 
ether  we  could  have  written  them  thus: 

Gm.  or  mil.      ' 

Spiritus  setheris  nitrosi, 

Aquse aa     foij       or       8 

4.  The  names  and  quaiitities  of  ingredients  having  been  determined, 
the  next  step  is  to  give  the  directions  to  the  compounder  (third  part  of 
prescription).  In  this  case  we  need  only  to  direct  that  the  substances 
be  mixed,  leavmg  to  the  compounder's  art  the  precise  order  or  method 
to  be  followed.  We,  therefore,  simply  use  the  abbreviation  of  Misce, — ■ 
M.,  which  is  placed  either  to  the  right  on  a  line  with  the  name  of  last 
ingredient  or  to  the  left  on  a  line  below. 

5.  Add  directions  to  the  patient  (fourth  part  of  prescription),  to  be 
preceded  by  the  character  Sig.  or  S.  (see  page  272). 

6.  The  date  name,  or  initials  of  patient  and  signature  will  complete  the 
prescription  (see  page  273). 

CONSTRUCTION  OF  PRESCRIPTIONS. 

Dentifrices. — If  we  desire  to  T\Tite  a  prescription  for  a  tooth  powder, 
we  consider  first  the  essential  qualities  of  the  ingredients  which  should 
enter  into  it.    Ordinarily  we  want  a  tooth  powder  to  be: 

1.  Antacid. 

2.  Slightly  abrasive  'just  sufficient  to  remove  acciun illation  of 
deposits) . 

3.  Aseptic  or  antiseptic. 

4.  Pleasant  to  the  taste. 
Occasionally  also  we  desire  it  to  be 

Astringent  or 

Stimulating, 
but  these  two  qualities  are  needed  in  pathologic  rather  than  normal 
conditions.     The  formula  need  not  be  complicated.     Prepared  chalk 


284  PRESCRIPTION  WRITING 

and  powdered  soap  will  really  cover  all  essentials,  except  that  taste 
may  be  further  consulted  as  to  flavoring. 

Written  out  in  simple  English,  we  may  have  a  combination  something 
like  this,  using  our  own  preference  for  either  the  apothecaries'  or  the 
metric  weights: 

1.  Take 

fof  prepared  chalk,                   ten  ounces,  or  310  grams. 

2.  -j  of  powdered  soap,                   two  ounces,  or  62  grams. 
[of  oil  of  wintergreen,              five  minims,  or  0 .  30  grams. 

3.  Mix  and  triturate  thoroughly. 

4.  Write:     Use  with  toothbrush  each  evening. 

5.  For  A.  B.,  Oct.  10,  1902.  (Chas.  Dale). 

But  custom  and  certain  advantages  lead  us  to  prefer  the  use  of  Latin 
terms  and  other  characters  as  follows: 

Gm. 

^. — Creta^  pra^paratae §x        or     310 

Saponis  pulv 5ij        or       62 

Olei  gaultherise TTlv       or  30 

M. — Triturate  thoroughlj*. 

Sig. — Use  with  toothbrush  each  evening. 
For  A.  B.,  Oct.  10,  1902  (Chas.  Dale.) 

This  formula  is  simply  suggestive  and  admits  of  any  desired  modi- 
fication or  addition.  Other  ingredients  and  other  proportions  of  these 
ingredients  will  be  employed  at  pleasure.  If  we  analyze  the  qualities 
of  such  a  combination  we  find  the  value  of  each  ingredient  to  be  distinct, 
as  here  indicated: 

Crela  prceparata  is  antacid  and  slightly  abrasive. 
Sapo  is  alkaUne,  detergent  and  antiseptic. 
Oleum  gaultherice  is  a  flavoring  agent. 

It  will  be  noticed  that  the  Latin  names  of  ingredients,  and  their 
adjectives,  are  given  in  the  genitive  case.  The  reason  for  this  appears 
in  the  English  version  of  the  formula,  the  reading  being:  Take  ten 
ounces  of  prepared  chalk,  etc. 

The  antacids  that  serve  the  same  purpose  as  prepared  chalk,  but 
which  are  less  abrasive,  are  magnesium  oxide,  magnesium  carbonate, 
sodium  bicarbonate  and  borax,  the  last-named  being  also  antiseptic. 

Powdered  pumice  and  charcoal  are  too  gritty  and  harsh  for  continued 
use.  They  may  injure  both  the  gums  and  the  enamel,  and  they  are, 
therefore,  to  be  discarded  from  our  formulas. 

Powdered  orris  root  (Radix  Iridis  Florentinse)  is  valued  by  many, 


CONSTRUCTION  OF  PRESCRIPTIONS  285 

because  of  its  reputed  tonic  influence  upon  the  mucous  membrane,  but 
it  is  not  an  antacid. 

The  antiseptics,  other  than  soap,  that  may  be  employed,  are  borax, 
resorcin,  naphtol  and  boric  acid.  The  last  named  may  be  combined 
with  sufficient  antacid  to  leave  the  reaction  of  the  mouth  alkaline  or 
neutral. 

The  flavoring  agents  include  any  of  the  pleasant  volatile  oils,  or 
powdered  drugs  containing  them — e.  g.,  powdered  cinnamon.  Some 
of  the  volatile  oils  are  costly,  and,  therefore,  not  commonly  used.  Oil 
of  rose  is  the  most  expensive.  These  oils  are  not  included  for  any 
medicinal  effect,  but  only  as  flavoring  agents;  therefore  they  are  used 
in  very  small  quantity. 

Coloring  agents,  such  as  carnaine  or  an  aniline  color,  may  be  added 
if  desired,  but  metallic  pigments  had  better  be  avoided,  for  fear  of 
staining  exposed  dentine. 

If  the  dentifrice  is  preferred  in  form  of  a  paste,  sufficient  glycerin 
may  be  added,  but  syrup  or  honey  are  to  be  avoided  on  account  of  being 
readily  fermentable.  For  the  same  reason  sugar  is  inferior  as  a  sweeten- 
ing agent.  Saccharine  may  be  used,  as  it  does  not  ferment,  and,  being 
about  500  times  sweeter  than  cane-sugar,  a  small  quantity  will  suffice. 

Anyone  desiring  his  own  special  formula  for  a  dentifrice  can  easily 
attain  his  object  through  a  little  experimentation  with  the  substances 
here  suggested,  and  the  effort  will  be  profitably  expended.  The  thought 
should  be  prominent,  however,  that  strong  antiseptics  are  not  constantly 
needed  in  normal  conditions;  and  the  more  thoroughly  the  mouth  and 
teeth  are  habitually  cleansed  the  less  will  they  be  required. 

Mouth  Washes. — Washes  for  the  mouth  and  teeth  may  be  needed  for 
the  following  purposes : 

1.  To  neutralize  acid  fluids,  whether  introduced  or  present  as  abnormal 
secretion. 

2.  To  cleanse  the  mouth. 

3.  To  disinfect  when  ferments  or  septic  bacteria  are  active. 

4.  To  prevent,  as  an  antiseptic,  the  growth  of  ferments  and  septic 
bacteria. 

5.  To  exert  an  astringent  action  upon  the  mucous  membrane. 

6.  To  stimulate  nutrition  of  the  mucous  membrane. 

Many  agents  are  employed  to  accomplish  these  purposes,  and  the 
possible  combinations  are  without  number.  But  it  may  be  stated  as  a 
cardinal  rule,  that  mouth  washes  should  possess  antacid  and  antiseptic 
properties.    It  is  impossible  even  in  health  to  maintain  a  strictly  aseptic 


286  PRESCRIPTION   WRITING 

condition  of  the  mouth,  while  in  disease,  local  or  general,  efforts  are  still 
less  availing.  It  is  often  essential,  therefore,  that  an  antiseptic  be 
freely  emplo\'ed,  always,  however,  with  due  appreciation  of  the  harm 
that  may  follow  the  improper  use  of  the  stronger  agents. 

Some  agents  addressed  to  a  single  purpose  (as  a  detergent  or  an  astring- 
ent) may  be  used  alone  in  aqueous  solution.  Alcohol  is  not  a  suitable 
vehicle  in  mouth-washes  unless  its  astringent  action  is  desired,  but  its  aid 
as  a  solvent  may  be  necessary.    In  any  case  it  must  always  be  diluted. 

The  two  main  points  to  consider  in  prescribing  a  mouth  wash  are 
efficiency,  and  safety  to  the  soft  tissues. 

Certain  agents,  including  creosote,  borax  and  boric  acid,  are  regarded 
as  quite  efficient  in  a  saturated  aqueous  solution  and  may  be  used  freely 
without  harming  the  tissues;  but  phenol,  corrosive  sublimate,  chloride 
of  zinc  and  formaldehyde  would  be  very  irritating  in  saturated  solution. 
They  must  be  very  largely  diluted  for  use  in  mouth  washes. 

One  of  the  most  efficient  agents  is  phenol,  but  it  should  not  be  used 
stronger  than  1  per  cent.;  and,  though  it  is  only  very  slightly  acid  in 
reaction,  it  is  well  to  use  an  alkali  with  it  as  follows: 


Gm.  or  mil. 

I^.— PhenoUs 2 

Sodii  bicarbonatis       ....        15 

Glycerini 30 

Aquae q.  s.  ad     200 

Sig. — Use  as  mouth  wash  every  three  hours 


(gr.  xxx) 
(3iv) 
(5j) 
(f§vij)--M. 


Another  efficient  similar  combination  in  Dobell's  solution.  (See 
formula,  p.  127). 

The  excellent  work  of  Dr.  W.  D.  Miller  has  shown  benzoic  acid  and 
salicylic  acid  to  be  among  our  most  efficient  mouth  antiseptics  when 
used  in  1  per  cent,  solution;  but  they  are  only  slighty  soluble  in  water, 
requiring  275  and  4()0  parts  respectively,  and  they  are  acid  in  reaction. 
It  is  found,  how^ever,  that  with  the  aid  of  borax  a  1  per  cent,  alkaline 
solution  of  either  of  these  may  be  prepared ;  although  it  is  probable  that 
their  antiseptic  power  is  less  in  an  alkaline  solution.  A  saturated 
aqueous  solution  of  borax,  with  1  per  cent,  of  either  salicylic  or  benzoic 
acid  added,  is  presented  in  the  following: 

Ciin.  i>r  mil. 

I^. — Sodii  boratis 5:  (3iss) 

Acidi  saUcylici 1 1  (gr.  xv) 

AqujB 100  (f5iij)— M. 

Dissolve  the  borax  in  the  water,  then  add  the  sahcyHc  acid. 

Sig.  — Mouth  wash. 


ABBREVIATED   TERMS   USED  IN  PRESCRIPTIONS  287 

Gm.  or  mil. 

I^. — Sodii  boratis Si-  (3iss) 

Acidi  benzoic!        .....  1  (gr.  xv) 

Aquae 100  (f5iij)— M. 

Dissolve  the  borax  in  the  water,  then  add  the  benzoic  acid. 

Sig.— Mouth  wash. 

Flavoring  agents  may  be  used  in  the  above  at  pleasure,  in  the  form  of 
medicated  waters,  such  as  aqua  cinnamomi,  or  a  little  volatile  oil. 
Creosote  may  be  ordered  in  its  official  preparation: 

mil. 

I^. — Aquae  creosoti 100 

Sig. — Mouth  wash.     Use  after  each  meal  and  at  bedtime. 

Hydrogen  dioxide  is  entirely  safe  to  use  in  the  official  3  per  cent, 
solution,  but  it  is  acid  in  reaction.    It  is  useful  in  septic  conditions. 

ABBREVIATED  TERMS  USED  IN  PRESCRIPTIONS. 

The  use  of  abbreviations  in  the  names  of  ingredients  and  in  the  direc- 
tions to  the  patient  is  to  be  discouraged.  The  following  list  is  intended 
more  for  reference  in  interpreting  abbreviated  prescriptions  than  for  use 
in  writing. 

aa ana .      .of  each. 

a.  c ante  cibum    .      .      .      .      .     before  meals. 

ad to,  up  to. 

adde add. 

ad.  Ub ad  libitum     .      .      .      .      .at  pleasure. 

aq aqua water. 

aq.  bull aqua  bulhens      ....     boihng  water. 

aq.  dest aqua  destillata    ....     distilled  water. 

aq.  ferv aqua  fervens       ....     hot  water. 

b.  i;  d bis  in  die twice  daily. 

Br.  P British  Pharmacopoeia. 

CO cubic  centimeter. 

eg centigram. 

chart charta,  chartula       ...  a  paper,  a  little  paper. 

cochl.  mag.       .      .      .     cochleare  magnum  .  .  tablespoon, 

cochl.  med.       .      .      .     cochleare  medium    .      .      .  dessertspoon, 

cochl.  parv.      .      ,      .     cochleare  parvum.   .      .      .  teaspoon. 

coUyr coUyrium eye  wash. 

coUut coUutorium         ....  mouth  wash. 

CO.,  comp compositus,  a,  um    .      .      .  compound. 

cong congius gallon. 

cort cortex bark. 

cum with. 

dil dilutus,  a,  um     ....  diluted. 

div divide divide. 

ext extractum extract. 

ft fiat,  fiant       .....  let  (it)  (them)  be  made. 

fl fluidus,  a,  um     .      .      .      .  fluid. 

fol foUa leaves. 


288  PRESCRIPTION   WRITING 

gtt gutta,  guttse       ....  drop,  drops. 

gm gram. 

gr grain. 

h.  s hora  somni at  bed-time. 

in  d in  die daily. 

L liter. 

liq liquor solution. 

mil milliliter. 

TTl minim. 

M misce mix. 

mist mistura mixture. 

N.  F National  Formulary. 

no numerus,  numero     .      .      .  number,  in  number. 

noct nocte by  night. 

non.  rep non  repetatur     .      .      .      .  let  it  not  be  repeated. 

O octarius pint. 

ol oleum oil. 

cm omni  mane every  morning. 

omn.  bih omni  bihora        ....  every  two  hours. 

omn.  hor omni  hora every  hour. 

omn.  noct.        .      .      .     omni  nocte every  night. 

part,  seq partes  sequales    ....  equal  parts. 

p.  c post  cibum after  meals. 

pil pilula pill. 

p.  r.  n pro  re  nata as  occasion  arises. 

pulv pulvis powder. 

q.  i.  d.,  q.  d.     .      .      .     quater  in  die       .      .      .     ^  four  times  a  day. 

q.  s quantum  sufficit      ...  as  much  as  necessary. 

I^ recipe take. 

rad radix root. 

rect rectificatus rectified. 

rep repetatur let' it  be  repeated. 

s.  a secundum  artem      .      .      .  according  to  art. 

ss semissis a  half. 

S.,  Sig signa sign  (write). 

or 

signetur let  it  be  labeled. 

sine without. 

solv solve dissolve. 

spir spiritus spirit. 

sp.gr specific  gravity. 

syr syrupus syrup. 

tab tabella tablet,  troche. 

tal tahs such,  Uke  this. 

t.  i.  d.,  t.  d.      .      .      .     ter  in  die three  times  a  day. 

tinct.,  tr.  ...     tinctura tincture. 

trit.        .....     tritura triturate. 

troch trochiscus troche,  lozenge. 

ung unguentum ointment. 

U.  S.  P United  States  Pharniacopa;ia. 

vel or. 

vin vinum wine. 

wt weight. 


CHAPTER  XXII. 
POISONS. 

A  poisox  may  be  defined  to  be  a  substance  which,  when  introduced 
into  the  body,  causes  disease  or  death.  But,  in  accepting  this  definition, 
foreign  bodies  or  agents  that  act  mechanically  must  be  excluded,  as,  for 
example,  a  bullet.  Certain  substances  also  that  produce  disease  in  the 
system  are  not  usually  classed  among  poisons.    Of  these  there  are: 

Venom,  the  natiu-al  protective  secretion  of  certain  reptiles  and  insects. 

Virus,  a  rather  indefinite  term  that  has  been  applied  to  the  microbic 
cause  of  an  infectious  disease  or  to  the  characteristic  poison  developed 
in  coiuse  of  the  disease. 

^Yith  the  recognition  of  the  definite  organisms  that  cause  the  several 
infectious  diseases  the  term  virus  has  fallen  somewhat  into  disuse.  In 
its  place  we  have  the  more  definite  terms  of  hacteriinn,  as  the  cause,  and 
toxin,  a  poisonous  product  of  the  growth  of  the  bacterium. 

[Antitoxin  is  a  substance  formed  in  the  body  as  a  reactionary  protec- 
tion against  the  action  of  a  toxin  of  a  disease.  The  presence  of  a  toxin  is 
necessary  to  stimulate  the  formation  of  the  antitoxin  which  is  capable 
of  neutralizing  it.  The  most  familiar  example  of  an  antitoxin  is  that 
of  diphtheria,  which  is  prepared  in  the  blood  of  the  horse  and  used  to 
neutralize  the  toxin  of  the  disease  in  the  human  being.] 

Ptomains  are  basic  organic  compounds  formed  by  the  action  of  bacteria 
upon  nitrogenous  matter.  Some  are  poisonous,  and  some  resemble 
vegetable  alkaloids  in  their  action. 

Leukomains  are  basic  substances  that  result  from  tissue  metabolism. 
Some  of  these  are  poisonous. 

The  usual  use  of  the  term  poison  refers  to  drugs  that,  when  taken  in 
overdose  or  in  concentrated  form,  produce  disease  or  death. 

The  law  recognizes  the  responsibility  that  attaches  to  the  sale  of 
poisons,  and  requires,  in  most  communities,  that  all  poisons,  except 
those  dispensed  upon  a  physician's  prescription,  shall  be  distinctly 
labeled,  and,  in  case  of  the  more  powerful  substances,  that  a  record 
shall  be  made  of  the  sale. 

The  substances  included  in  the  list  of  poisons  vary  very  greatly  in 
their  action,  as  to  time  required  for  their  poisonous  effects,  part  of  the 
19 


290  POISONS 

system  attacked,  and  character  of  symptoms  produced.  Thus  arsenic, 
one  of  the  most  destructive  poisons,  acts  slowly,  while  carbolic  acid  may 
cause  death  in  a  very  short  time,  as  is  true  also  of  hydrocyanic  acid. 
Strychnine  causes  frightful  convulsions,  while  morphine  produces  coma. 
The  simple  outline  here  given  serves  to  aid  in  grouping  poisons  accord- 
ing to  site  of  action: 

1.  Those  acting  locally: 

(a)  Corrosives. 
(6)  Irritants. 

2.  Those  acting  upon  the  blood,  or  blood  poisons. 

3.  Those  acting  upon  the  nervous  system,  or  nerve  poisons. 

4.  Those   acting  upon   special   organs: 

(a)  Upon  heart. 
(6)  Upon  kidneys. 
(c)  Abortives. 
Concerning  abortives,  it  should  be  noted  that  they  are  really  irritants. 
Among  other  effects  they  may  disturb  the  gravid  uterus,  but  this  is  only 
one  of  the  dangers  of  their  action.    As  a  class  they  must  be  regarded  as 
very  dangerous  agents  and  at  the  same  time  uncertain  as  to  any  special 
action. 

(For  s\Tiiptoms  and  treatment  of  poisoning  by  the  various  substances, 
see  Table  of  Poisons  and  Antidotes.) 

Modes  of  death  are  appropriately  defined  at  this  place  as  related  to 
poisons. 

1.  Failure  of  Circulation. — Syncope  is  sudden  failure  of  the  circulation, 
due  to  depression  of  the  heart  from  various  causes.  It  may  be  temporary, 
as  in  case  of  ordinary  fainting,  or  it  may  be  complete,  due  to  paralysis 
of  the  heart. 

Asthenia  is  gradual  failure  of  the  circulation  by  depression  of  the 
heart,  as  occurs  in  fatal  cases  of  acute  infectious  diseases. 

2.  Failure  of  Eespiration. — Asphyxia  is  the  condition  of  non-oxygen- 
ation  of  the  blood.  It  may  be  caused  by  complete  shutting  off  of  the  air 
(apnea),  as  in  drowning,  or  it  may  be  due  to  the  displacement  of  oxygen 
by  other  gases.    It  may  be  partial  or  complete. 

3.  Paralysis  of  Brain  Centers. — Coma  is  a  paralysis  of  the  conscious 
and  the  reflex  centers  of  the  brain.  It  may  be  caused  by  pressure,  as 
in  apoplexy,  or  it  may  be  due  to  the  action  of  a  narcotic. 

The  sig7is  of  death  usually  relied  upon  are  cessation  of  respiration, 
cessation  of  circulation  and  paralysis  of  pupil. 


TABLE  OF  POISONS  AND  ANTIDOTES. 

(This  table  is  adapted  from  the  author's  Tables  for  Doctor  and  Druggist,  by  permis- 
sioa  of  the  pubhsher,  E.  G.  Swift,  Detroit,  Mich.) 


Poison. 


Toxic 
dose. 


Action. 


Prominent  symptoms. 


Antidotes  and  treatment. 

(Antidotes  in  italics.) 


Acid,  carbolic 
•».^__i2henol) 


Acid,  hydrocyanic. 

Acid,  prussic 

.(U.S.  P.  2%) 
Bitter  almond,  oil 
Potass,  cyanide 

Acid,  oxalic     . 
Soluble  oxalates 

Mineral  acids. 
Acid,  hydrochloric, 
nitric, 
sulphuric, 


tZ 


Aconite      .      .      .      . 
Tincture  of  root 
Aconitine 

1/A.mmonia 

Water  of  (10%) 

Stronger  water  of 

(28%) 
Carbonate    of    am- 
monium 
.    Arsenic  trioxide    . 
^— ^Arsenous  acid, 
white  arsenic 
Arsenic  disulphide, 
red    sulphide    of 
arsenic,  realgar 
Arsenic  trisulphide, 
orpiment.     King's 
yellow 
Arsenite  of  copper     . 

Scheele's  green 
Aceto-arsenite  of  cop- 
per; Paris  green; 
,  Schweinfurth  green 
1  /Belladonna      (leaves, 
^    ■  berries  or  root) 
Atropine 


By  stomach 
By  inhalation  . 


m30 

gr.  3-4 

fatal 

34 


m22 

gr.  Vso 


f3i* 
fatal 


gr.  2 
fatal 


gr.  i-i 
fatal 


Corrosive; 
systemic 
poison 

Depresses 
brain  and 
heart 


Irritant; 
general 
depressant 


Corrosive 


Depresses 
heart  and 
nervous 
system 

Irritant 


Caustic 


Escharotic ; 
irritant 
when 
diluted 


Deliriant 
narcotic ; 
dilates 
pupil  and 
paralyzes 
accommo- 
dation 

Caustic ; 
sedative 
to  nerve 
centers 


Dryness  of  mouth  and 
pharynx;  eyes  bright, 
pupils  dilated;  face 
flushed;  rapid  respira- 
tion; delirium,  convul- 
sions, stupor 


Severe  symptoms  of  irri- 
tation; depression  of 
nerve  centers;  paral- 
ysis 


Pain  followed  by  numb-  | 
ness;  white  stain;  col- 
lapse; stupor;  dyspnea 

Sudden  various  symp- 
toms of  depression ; 
dyspnea 


Abdominal  pain,  vomit- 
ing, collapse,  stupor 

Thirst,  vomiting,  burn- 
ing pain  in  throat  and 
stomach;  tissues  cor- 
roded; more  or  less 
collapse 


Tingling  and  numbness; 
slow,  weak  pulse;  dys- 
pnea; pupil  usually 
dilated 

Irritation  in  air  pass- 
ages and  stomach  with 
pain,  vomiting  and 
purging ;  prostration ; 
odor  of  ammonia 


Faintness ;  gastro-intes- 
tinal  irritation,  vom- 
itiiig  and  piirging, 
thirst ;  collapse  ; 
cramps,  conviilsions  or 
coma ;  in  some  cases 
collapse  is  most  promi-  ' 
nent  symptom,  in  | 
others  stupor;  some  i 
cases  resemble  cholera; 
usually  the  symptoms  , 
do  not  develop  quickly  i 


Emesis:  Albumin,  alcohol,  sul- 
phate of  magnesium  or  other 
soluble  sulphate;  oil  or  other 
demulcents;  stimulants. 

Artificial  respiration;  stomach 
tube;  cold  douche  to  head  and 
chest,  or  alternate  with  hot; 
ammonia  inhalation;  mixture 
of  persulphate  and  protosulphate 
of  iron. 

Carbonate  of  lime  in  any  form, 
magnesia,  lime-water ;  anodynes, 
demulcents,  stimulants. 

Glass  of  waterf  immediately  to 
dilute  acid,  follow  by  lime- 
water,  magnesia,  soap  or  plaster 
from  wall;  no  carbonates;  de- 
mulcents, stimulants;  mor- 
phine hypoderm.  if  needed;  do 
not  use  stomach  pump. 

Empty  stomach;  atropine,  am- 
monia, digitalis  with  glonoin; 
strychnine;  slight  galvanic 
shock  recommended;  tannin  in 
aconitine  poisoning. 

Water  immediately  to  dilute, 
follow  by  lemon-juice  or  vinegar. 
Inhalation  of  acetic  acid  vapor; 
stomach  pump  should  not  be 
used;  demulcents,  anodynes, 
stimulants. 

Aid  emesis  (unless  vomiting  has 
been  profuse)  by  the  use  of 
mustard  or  sulphate  of  zinc; 
may  wash  out  stomach  by 
means  of  flexible  tube,  but 
stomach  pump  should  not  be 
used;  freshly  prepared  hy- 
drated  sesquioxide  of  iron% 
freely,  and  follow  by  an  emetic, 
then  by  castor  oil;  demulcents 
anodynes,  stimulants,  external 
warmth. 


Emetics  or  stomach  tube;  tannic 
acid,  animal  charcoal,  follow  by 
emetic,  and  later  by  castor 
oil;  heat  or  cold  externally,  or 
alternately;  _  artificial  respira- 
tion and  stimulants  if  neces- 
sary; morphine  maybe  of  value. 

Dilute  with  large  draughts  of 
water;  very  dilute  solutions  of 
alkalies;  ether;  brisk  cathartic 
alkalies. 

Ammonia  by  inhalation. 


*  Poisonous  effect  depends  more  upon  concentration  than  upon  quantity. 

t  There  can  be  no  objection  to  the  use  of  water  in  sulphuric  acid  poisoning,  if  sufficient  is  employed. 
In  mixing  100  c.c.  of  water  at  70°  F.  with  10  c.c.  of  sulphuric  acid,  the  temperature  increased  to  only 
111°  F.;  and  in  mixing  200  c.c.  of  water  (a  glassful)  with  10  c.c.  of  sulphuric  acid,  the  temperature 
increased  to  only  94°  F. 

J  This  is  the  Ferri  Hydroxidum,  U.  S.  P.  To  prepare  it  freshly  use  tincture  of  chloride  of  iron, 
Monsel's  solution,  or  solution  of  tersulphate  of  iron  (any  solution  of  &  ferric  salt)  and  milk  of  magnesia. 
Dilute  the  iron  solution  with  several  times  as  much  water,  also  the  milk  of  magnesia  with  an  equal  quan- 
tity. Mix  the  two  and  administer  freely  at  once,  giving  one-half  to  one  glassful  (100  to  200  mils.)  of 
the  mixture.  [Water  of  ammonia  may  be  substituted  for  the  milk  of  magnesia,  but  the  product  requires 
washing  to  remove  the  sharp  taste  and  odor  of  ammonia.] 


292 


TABLE  OF  POISONS  AND  ANTIDOTES 


Prominent  symptoms. 


Antidotes  and  treatment. 

{Antidotes  in  italics.) 


Camphor  .      .      .      .     gr.  20 


Cannabis  indica 


Cantharides    . 
Tincture 
Cantharidin 

(active  principle) 


Carbolic  acid;  see 

Acid,  carbolic 
Carbonic  anhydride,* 

carbonic    acid    gas 

Carbonic  oxidet  . 
Charcoal  gas 
Coal  gas 
Illuminating  gas 


Castor-oil  beans  . 

(seeds  of  Ricinus 

communis) 
Chloral  hydrate   . 


gr.  23 
f51 

fatal 


Three 
seeds 
fatal 

gr.  30 


Disturbs 
brain  and 
nerve 
centers 

Intoxicant 


Irritant; 
sometimes 
aphrodisiac 


Regarded 
as  narco- 
tic 

Destroys 
I     oxygen- 
carrying 
power  of 
the  red 
blood  cor- 
puscles 


Irritant 


Hypnotic; 
sedative; 
paralyzes 
nerve 
centers; 
narcotic 


Bv  inhalation 


Chloroform 

By  stomach  .       f54 

fatal  to 
adult; 

fol 
to  child 

mio 

quickly 
inhaled 
has     I 
been 
fatal 
Coal  gas;  see  Carbonic 
/  oxide 
VCocaine  .    gr.  J  oi 

Cocaine  hydrochloride  less 
1  gr.  I 
I    fatal 


Locally 
irritant; 
anesthetic 


34 


51 

fatal. 


Anesthetic; 

paralyzes 

nerve 

centers; 

may 
paralyze 

heart 

Stimulant; 
later    de- 
pressant; 
locally 
paralyzant 

Irritant 


Vertigo;  pain  in 
stomach;   delirium   or 
stupor;  convulsions 

Hilarity;  mental  confu- 
sion; pupils  dilated; 
drowsiness 

Gastro-intestinal  irrita- 
tion with  pain,  vomit- 
ing and  purging;  pain 
in  loins;  severe  irrita- 
tion of  genito-urinary 
organs;  sometimes 
erotic  excitement;  col- 
lapse, stupor,  coma;  in 
some  cases  delirium  or 
convulsions 

Headache,   giddiness, 
drowsiness;      cyanosis 
if  oxygen  is  excluded 

Headache,  vertigo,  pros- 
tration, vomiting,  dys- 
pnea; feeble  and  rapid 
pulse,  stupor;  in  some 
cases  convulsions 


Severe  gastro-intestinal 
irritation 

Stupor;  pupils  at  first 
contracted,  later  di- 
lated; temperature  re- 
duced; respirations 
slow,  or  later  may  be 
rapid  and  shallow 


When  taken  by  the 
stomach:  gastric  irri- 
tation, vomiting,  odor 
of  chloroform;  later, 
stupor,  coma 

When  inhaled:  loss  of 
consciousness ;  syncope 
sometimes  early;  pro- 
found narcosis;  death 
by  failure  of  heart  or 
respiration 


Faintness  and  collapse, 
or  delirium,  or  convul- 
sions; symptoms  irreg- 
ular 

Gastric  irritation  with 
pain  and  vomiting  of 
greenish  matter,  purg- 
ing; jaundice  in  some 
cases;  convulsions  or 
paralysis  may  follow. 


Emesis;  follow  by  castor  oil  or 
sulphate  of  magnesium;  stimu- 
lants if  necessary  to  support 
nerve  centers. 

Meet  indications  as  they  arise 
(there  is  no  case  on  record  of 
fatal  poisoning  by  this  drug). 

Emesis;  stomach  tube  may  be 
used;  demulcents;  no  oils 
should  be  employed,  as  they 
dissolve  cantharidin  and  favor 
its  absorption;  anodynes  by 
the  rectum;  opium,  cocaine, 
belladonna;  morphine  hypo- 
dernucally,  or  anesthetics  if 
suffering  is  intense;  leeches  to 
hypogastrium;  warm  baths; 
mild  diuretics  and  cathartics. 

Supply  fresh  air  or  oxygen;  arti- 
ficial respiration  and  stimu- 
lants if  necessary. 

The  hemoglobin  being  so  altered 
as  to  be  incapable  of  taking  up 
oxygen,  the  treatment  by  fresh 
air  and  oxygen  is  not  so  suc- 
cessful as  in  simple  asphyxia; 
still  this  means  of  giving 
oxygen  to  the  blood  cells  that 
remain  uninjured  should  be 
employed;  in  urgent  cases 
transfusion  of  blood. 

Emesis,  demulcents,  anodynes 
and  stimulants  if  necessary. 

Emesis  or  stomach  tube;  exter- 
nal warmth  very  important;! 
arouse  patient;  stimulate  re- 
flexes by  external  application 
of  mustard,  friction,  slapping 
smartly ;  faradization;  atropine, 
strong  coffee,  strychnine,  am- 
monium carbonate  and  digi- 
talis if  urgent;  artificial  or 
forced    respiration;    oxygen. 

Emetic  or  use  of  stomach  tube; 
arouse  patient;  recumbent  pos- 
ture; stimulants;  strychnine, 
caffeine,  digitalis;  external 
warmth,  artificial  respiration  if 
necessary. 

Stop  inhalation  and  supply  fresh 
air;  head  low  to  favor  gravi- 
tation of  blood  to  the  brain; 
artificial  respiration,  external 
warmth  and  friction;  faradiza- 
tion to  muscles  of  respiration; 
massage  of  heart;  strychnine, 
caffeine,  digitalis. 

Tannic  acid,  potassium  perman- 
ganate or  purified  animal  char- 
coal; empty  stomach;  treat 
conditions  as  they  arise. 

Aid  emesis;  alhumin  freely  is  best 
antidote;  milk,  mucilaginous 
drinks;  ferrocyanide  of  potas- 
siitm  if  pure;  opium;  stimula- 
tion if  necessary. 


Copper  salts  . 

Arsenite;  see  Arsenic 
Carbonate 
' '  Natural ' '   verdi- 
gris 
Subacetate,    verdi- 
gris 
Sulphate,   blue   vi- 
triol 

*  An  atmosphere  containing  1  to  2  per  cent,  of  carbonic  anhydride,  with  a  corresponding  diminution 
of  oxygen,  is  poisonous;  with  5  to  10  per  cent,  of  carbonic  anhydride,  and  oxygen  correspondingly 
lessened,  death  will  occur,  while  it  requires  10  to  20  per  cent,  to  extinguish  a  flame. 

t  Carbonic  oxide  is  more  poisonous.  According  to  Sollmann  (Pharmacology)  it  combines  with 
hemoglobin  200  times  more  readily  than  does  oxygen. 

J  Brunton  and  Strieker  found  that  animals  which  had  received  a  dose  of  chloral  that  would  certainly 
kill  them  if  they  were  left  exposed,  recovered  when  wrapped  up  in  cotton-wool,  and  if  the  dose  were 
increased  so  as  to  kill  the  animal  even  when  thus  wrapped  up,  it  could  still  be  kept  alive  by  being 
put  into  a  warm  place  so  as  to  keep  up  its  temperature  artificially.     A  still  larger  dose  was  fatal. 


TABLE  OF  POISONS  AND  ANTIDOTES 


293 


Poison. 


Toxic 
dose. 


Prominent  symptoms. 


Antidotes  and  treatment. 
(A'ntidotes  in  italics.) 


Corrosive   sublimate; 

see  Mercuric   chlor 

ride. 
Creosote   .      .      .      . 

Croton  oil. 


Cyanide      of     potas- 
sium;   see    Acid, 
hydrocyanic 
Elaterium 
Elaterin       (several 
times    stronger 
than  elaterium) 
Ether,  by  stomach    . 

by  inhalation    . 


Formalin  . 


Fungi*       .... 

Amanita  muscaria, 
Agaricus  phalloides 
and  others  (the  irri- 
tant principle  is 
destroyed  by  boil- 
ing, drying,  or  by 
acids,  alkalies  or 
alcohol;  but  the 
narcotic  principle, 
muscarine,  resists 
the  action  of  heat, 
drying,  or  these  re- 
agents) 

Hyoscyamus,  hen- 
bane 
Hyoscyamine 
Hyoscine 

Iodide    of    potassium 
(acute  poisoning) 


Iodine  (acute  poison- 
ing) 
Tincture. 

Iron  salts  .... 
Chloride,  tinct.  of 
Sulphate,  copperas 


Laudanum. 

See  Opium 
Lead  salts 

Acetate ;    sugar    of 

lead 
Carbonate;     white 

lead 
Oxide,  red;  red  lead 

Mercuric  chloride 
(.corrosive  subli- 
mate;  bichloride 
of  mercury) 


Mercuric  cyanide 
(similar  to  above) 


mso 

fatal 


Irritant 

Irritant; 
drastic 
cathartic 


Drastic 
cathartic 


Irritant 
Anesthetic 


Irritant 


Irritant ; 
narcotic 


gr.  3 
fatal 


Similar    to 

belladonna; 

but  more 

hypnotic 

Irritant 


Irritant 
Irritant 


Irritant 
in  acute 
poisoning 


Corrosive 


Gastro-intestinal  irrita- 
tion 

Violent  gastrointestinal 
irritation;  purging, 
collapse  and  other 
symptoms  resembling 
those  of  cholera 

Violent  vomiting  and 
purging  with  severe 
griping;  collapse 

Gastro-intestinal  irrita- 
tion 

Narcosis;  cessation  of 
respiration 


Severe  pain  in  throat 
and  stomach;  vomit- 
ing 


Gastro-intestinal  irrita- 
tion, pain  and  vomit- 
ing; various  nervous 
syrnptoms;  headache, 
vertigo,  visual  dis- 
turbances; in  some 
cases  delirium  or  coma 


Same  as  in  belladonna 
poisoning 

Gastro-intestinal  irrita- 
tion, vomiting  and 
purging;  headache,  in 
some  cases  salivation; 
frequently  an  erup- 
tion; prostration 

Similar  to  above 


Gastric    irritation     and 
pain;  vomiting 


Gastro-intestinal  irrita- 
tion with  severe  colic, 
vomiting,  constipa- 
tion; if  severe,  convul- 
vulsions  may  occur 


Symptoms  occur  quite 
promptly;  burning  in 
throat  and  stomach, 
nausea  and  vomiting; 
abdomen  swollen  and 
tender;  severe  purg- 
ing with  straining; 
discharges  frequently 
bloody;  collapse,  stu- 
por, convulsions 


Dilute  freely  with  water,  then 
emesis;  follow  by  demulcents. 

Demulcents,  anodynes;  mor- 
phine hypodermically. 


Anodynes,  morphine  hypoder- 
mically, demulcents,  stimu- 
lants. 

Stimulate  elimination;  demul- 
cents; stimula-nts  if  needed. 

Stop  inhalation;  abundance  of 
fresh  air;  artificial  respiration, 
external  warmth,  strychnine, 
caffeine;  faradization. 

Dilute  poison  with  warm  water 
freely;  if  vomiting  does  not 
occur  the  stomach  should  be 
thoroughly  washed  by  means 
of  tube;  demulcents,  anodynes; 
ammonia  as  antidote. 

Emetic  and  cathartic  (common 
salt  or  mustard  as  emetic) ; 
demulcents  and  other  treat- 
ment according  to  indications; 
atropine  hypodermically  is 
recommended  as  physiological 
antidote;  tannic  acid  has  been 
thought  to  be  useful;  purified 
anim,al  charcoal. 


Same  as  for  belladonna  poison- 
ing. 


Aid  emesis;  demulcents,  dilu- 
ents, anodynes,  stimulants  if 
needed. 


Starch  freely,  follow  by  evacu- 
ants;  other  treatment  as  above. 

Dilute  with  draught  of  water 
immediately;  dilute  solution 
of  sulphide  of  potassium,  so- 
dium or  ammonium;  aid  emesis 
by  large  draughts  of  warm 
water;  demulcents,  anodynes; 
stimulants. 

Aid  emesis;  sulphate  of  mag- 
nesium or  other  soluble  sul- 
phate, followed  by  emetic; 
stimulate  sweating  by  exter- 
nal warmth;  later  iodide  of 
potassium  or  very  dilute  sul- 
phuric acid,  or  both. 

Albumin  freely  (white  of  one 
egg  to  each  0.25  gm.  (4  grains) 
of  poison  swallowed) ;  as  a 
substitute  for  albumin  wheat- 
flour  paste  or  milk;  emesis 
after  poison  is  neutralized; 
demulcents,  morphine  hypo- 
dermically; stimulants  inter- 
nally and  heat  or  friction 
externally;  continue  white  of 
egg  for  one  to  two  weeks. 


*  For  an  extensive  and  illustrated  description  of  edible  and  poisonous  fungi,  see  Reference  Hand- 
book of  the  Medical  Sciences,  vol.  iii,  New  York. 


294 


TABLE  OF  POISONS  AND  ANTIDOTES 


Poison. 


Toxic 
dose. 


Action. 


Prominent  symptoms. 


Antidotes  and  treatment. 

{Antidotes  in  italics.) 


Mercury  salts 

(The  salts  other 
than  bichloride  and 
cyanide  are  toxic 
in  proportion  to  sol- 
ubility) 

Morphine 
See  Opium. 

Nitrite  of  amyl     . 

Nitroglycerin,  glonoin 


Nux  vomica  .  .  .  gr.  30 
Alcoholic  extract,  ;  gr.  3 
Strychnine        .      .     gr.     | 


Irritant 


Opium 

Camphorated  tinc- 
ture; paregoric 
(contains  about  J 
grain  of  opium  to 
a  fluidrachm) 

Tincture;  lauda- 
num (this  and  all 
other  fluid  prep- 
arations except 
paregoric  contain 
10%  of  opium) 

Codeine 
Morphine    . 
Narcotine 
Heroin 


Increases 
irritabil- 
ity of 
spinal 
cord 


gr.  4-5  ;  1st  stage 
fatal 


gr.  h 
fatal 


2d  stage 
narcotic 


Symptoms  of  gastro- 
intestinal irritation  in 
varying  degree,  ac- 
cording to  the  amount 
and  solubility  of  salt 


Flushing  of  face,  suc- 
ceeded by  pallor;  pu- 
pils dilated;  respira- 
tion irregular;  pulse 
weak 

Muscular  twitching; 
tonic  spasms,  with 
intervals  of  rest;  ex- 
treme extension  of 
back  so  that  body 
may  rest  upon  the 
heels  and  head;  cor- 
ners of  the  mouth 
drawn  up;  later  jaws 
become  fixed;  death 
by  asphyxia  or  exhaus- 
tion; consciousness  re- 
mains until  near  death 

Often  slight  stimula- 
tion or  excitement 


Intoxication,  drowsiness 
and  stupor;  pupils  are 
contracted;  pulse  slow 
and  full;  respiration 
slow  and  often  stertor- 
ous; face  flushed, 
sometimes  cyanosed; 
unconsciousness  seems 
complete;  but  patient 
can  be  partially 
aroused  during  this 
stage  by  shaking  or 
shouting 


I  Prompt   emesis   by   mustard   or 
I     sulphate    of    zinc;    follow    by 
{     albumin   or  milk,   after  which 
induce  further  emesis  and  pur- 
gation; meet  other  indications 
as  they  arise. 

Cold  to  head,  artificial  respira- 
tion, ergot,  strychnine,  digi- 
talis; warmth  externally. 


If  seen  early  evacuate  stomach, 
then  give  tannic  acid  freely, 
and  follow  by  a  quick  emetic; 
bromide  of  sodium  in  large 
doses,  gm.  4-16  (31-4),  every 
half  hour,  if  necessary;  chloral, 
gm.  1-2  (gr.  15-30);  keep 
patient  very  quiet;  when  con- 
vulsions are  severe,  inhala- 
tions of  ether  or  chloroform; 
forced  respiration*  if  asphyxia 
threatens;  curarine  hypoder- 
mically  has  been  suggested; 
bladder  should  be  emptied. 

Evacuate  stomach  by  use  of 
mustard  stirred  up  in  luke- 
warm water,  aided  by  sul- 
phate of  zinc,  gm.  1.3-2  (gr. 
20-30)  if  vomiting  does  not 
speedily  occur;  meanwhile  tan- 
nic acid  should  be  given 
freely,  or  ipotassium  perm,anga- 
nate;  wash  out  stomach;  the 
stomach  tube  may  be  useful; 
apomorphine  0.005  gm.  ('/12 
gr.)  hypodermically  as  emetic 
if  patient  cannot  swallow. 

Maintain  respiration:  (1)  By 
arousing  patient  and  stimu- 
lating reflex  activity  by  ex- 
ternal stimulation,  shouting, 
smart  slapping,  frictions;  far- 
adization, alternate  douche  of 
quite  hot  (as  hot  as  the  hand 
can  bear)  and  ice-cold  water 
to  head  and  chest;  cautious 
inhalations  of  ammonia;  (2) 
by  strong  coffee  freely  or  caf- 
feine hypodermically;  atropine 
hypodermically  in  ordinary 
doses  only,  to  be  repeated  ac- 
cording to  the  state  of  the 
respiration;  strychnine.  (3)  If 
respiration  is  slow,  or  rapid 
and  shallow,  so  that  in  either 
case  insufficient  air  enters  the 
lungs,  artificial  respiration  or 
forced  respirationt  must  be 
employed  without  intermission 
until  proper  respiration  is 
established;  inhalation  of  oxy- 
gen; catheterization  should  not 
be  neglected,  and  large  ene- 
mata  of  warm  water  may  aid 
elimination. 


*  See  note  under  Opium. 

t  The  principle  of  forced  respiration,  as  practised  in  physiological  experiments  was  applied  to  the 
treatment  of  opium  poisoning  by  the  late  Dr.  George  E.  Fell,  of  Buffalo,  N.  Y.  The  apparatus  used 
consists  of  bellows,  face-mask  and  the  necessary  rubber  tubes,  with  stopcock  arranged  to  facilitate 
imitation  of  the  natural  respiratory  rhythm,  and  to  allow  the  addition  of  oxygen  to  the  inspired  air. 
Dr.  Fell  employed  the  method  in  eleven  cases  that  seemed  hopeless  with  the  use  of  ordinary  means 
of  treatment  and  in  three  cases  that  were  absolutely  hopeless.  Of  the  eleven  cases  eight  were  saved. 
The  puhnotor  is  an  apparatus  that  supplies  oxygen  in  connection  with  forced  respiration.  In  expert 
hands  it  is  efl5cient,  but  is  not  so  commonly  available  as  ordinary  artificial  respiration. 


TABLE  OF  POISOXS  AXD  A  XT  I  DOTES 


295 


Poison. 


Toxic 
dose. 


Prominent  symptoms. 


Antidotes  and  treatment. 
(Antidotes  in  italics.) 


See     Acid, 
oxalic 


Oxalates  ^1 
Oxalic      i^ 

acid      J 
Paregoric;  see  Opium 
Paris    green;    see 

Arsenic 
Phosphorus     . 


Potassa      .... 

Soda 

(Soda  as  a  poison 
is  very  similar  to 
potassa.) 

Liquor  potassse 

Liquor  sodae 

Conimercial  potash 
and  soda  are  im- 
pure carbonates 
containing  much 
free  alkali 
Potassium  bitartrate; 

cream  of  tartar 
Potassium  chlorate    . 


Potassium  nitrate 


Potassium  sulphate  . 
Prussic  acid;  see  Acid, 

hydrocyanic 
Red   lead;    see    Lead 

salts 
Red    precipitate;    see 

Mercury  salts 


gr.  1 
fatal 


34* 


3d  stage, 
paraly- 
zant 


Irritant 


Caustic 


52 

fatal 

fatal 


36 
fatal 


310 

fatal 


Irritant ; 
purgative 

Irritant 
believed 
to  pro- 
duce 
serious 
changes 
in  the 
blood 

Irritant 


Irritant 


Prostration,  coma;  res- 
piration may  become 
more  rapid  and  shal- 
low, but  is  usually  slow 
then  ceasing  entirely; 
pulse  weaker  and  more 
rapid;  face  is  cyanosed, 
though  sometimes  pal- 
lid ;  before  death  occurs 
pupils  become  dilated; 
reflexes  abolished;  con- 
\mlsions  may  occur; 
death  usually  by  fail- 
ure of  respiration 


Symptoms  usually  do 
not  appear  until  after 
a  few  hours;  then 
weakness,  nausea 

with  vomiting,  and 
other  symptoms  of 
gastric  irritation; 
vomited  matters  are 
luminous  in  the  dark, 
and  have  the  odor  of 
phosphorus; later 
jaundice  and  in  gome 
cases  delirium,  con- 
vulsions, coma;  hem- 
orrhages may  occur; 
temperature  may  be 
greatly  reduced;  in 
some  cases  death  oc- 
curs early  and  symp- 
toms are  not  typical 

Burning  and  pain  in 
stomach  and  abdo- 
men; severe  vonaiting 
and  purging;  prostra- 
tion 


Sustain  circulation;  strychnine, 
caffeine,  external  heat  and  fric- 
tion; digitalis  if  heart  failure 
threatens;  strong  infusion  of 
coffee  by  enema;  keep  up  arti- 
ficial or  forced  respiration  with 
or  without  oxj'gen;  morphine 
is  eliminated  into  the  stomach, 
therefore  it  should  be  washed 
out  frequently  with  a  solution 
of  potassium  permanganate. 


Sulphate  of  copper,  0.2  gm.  (3 
grains)  in  dilute  solution 
every  five  minutes  as  antidote 
and  to  induce  emesis;  if  at  hand 
crude  acid  French  oil  of  turpen- 
tine, or,  as  a  substitute  for  it, 
old  oxidized  oil  of  turpentine, 
and  follow  by  a  quick  saline 
cathartic;  ordinary  turpentine 
is  of  no  value  and  may  be 
dangerous,  as  oils  should  be 
avoided  because  they  are  sol- 
vents for  phosphorus;  after 
poison  is  neutralized  and 
removed  employ  demulcents; 
mucilaginous  drinks,  anodynes 
and  stimulants  if  necessary. 


A  large  draught  of  water  im- 
mediatelj%  and  follow  -nith 
diluted  xineaar  or  lemon-juice; 
albumin,  oils,  acidulated  de- 
mulcent drinks;  opium  or 
morphine  to  relieve  pain; 
stimulants. 


Gastro-intestinal  irrita- 
tion 

Gastro-intestinal  irrita- 
tion -with  pain  and 
vomiting;  irritation  of 
kidneys,  often  with 
suppression  of  urine 
and  other  symptoms 
of  acute  nephritis; 
cyanosis  and  nervous 
symptoms  may  occur 

Gastro-intestinal  irrita- 
tion with  violent  vom- 
iting, and  in  some 
cases  purging;  mus- 
cular weakness,  col- 
lapse; various  ner^-ous 
symptoms  may  occur 


Similar  to  above 


Demulcents;  chalk  or  magriesia 
mixed  with  water;  opium. 

Demulcents,  saline  purgatives 
and  diuretics;  calomel  may 
be  valuable;  coffee  or  caffeine; 
stimulants  moderately;  heat 
externally;  transfusion  of  blood 
is  recommended. 


Dilute  at  once  with  large 
draught  of  warm  water  and 
promote  emesis;  give  brisk 
non-irritating  cathartic;  follow- 
by  demulcent  drinks;  keep 
patient  warm;  anodj'nes  and 
stimulants  as  needed;  if  col- 
lapse occurs,  warmth,  friction, 
or  mustard  externally. 

Same  as  for  potassium  nitrate. 


■  Poisonotis  effect  depends  rather  upon  concentration  than  quantity. 


296 


TABLE  OF  POISONS  AND  ANTIDOTES 


Poison. 


Toxic 
dose. 


Action.     I    Prominent  symptoms. 


Antidotes  and  treatment. 

(Ay^tidotes  in  italics.) 


Silver  nitrate 
Soda;  see  Potassa 
Stramonium 

(Similar    to    bella- 
donna as  a  poi- 
son) ;    see    Bella- 
donna 
Strychnine;   see   Nux 

vomica 
Sugar     of    lead;     see 

Lead  salts 
Tobacco 


gr.  30 


Irritant 


.  „     -       Irritant; 

Nicotine     (one     of    A  few    ■     sedative 
the    most   active '    drops 
poisons  known)     i    prob- 
ably 
fatal 
Turpentine,  oil  of      .        ...       Irritant; 
narcotic 


Verdigris;  s^e  Copper 
salts 

White  lead;  see  Lead 
salts 

Zinc  chloride  . 

"Burnett's  Disin- 
fecting Fluid"  has 
200  grains  of  zinc 
chloride  in  one 
fiuidounce 

Zinc  sulphate 


Severe  gastric  irritation,  Solution  of  common  salt  freely; 
vomiting,  convulsions;  albumin;  mucilaginous  drinks; 
later  diarrhea  other   treatment   as    the    case 

may  require. 


32-4 


Corrosive 


Irritant; 
emetic 


Nausea,  vomiting,  in 
some  cases  purging; 
pain  in  stomach; 
prostration;  delirium; 
cramps;  rapid,  weak 
pulse;  collapse 

Gastric  irritation;  vom- 
iting and  purging  in 
some  cases;  irritation 
of  urinary  organs  with 
urine  lessened;  uncon- 
sciousness; convul- 
sions; collapse 


Violent  irritation  of 
stomach  immediately, 
with  vomiting  and 
pain;  tissues  corroded; 
nervous  symptoms; 
collapse 

Gastric  irritation;  vom- 
iting 


Aid  emesis  by  large  draughts 
of  warm  water;  tannic  acid; 
strychnine,  demulcents,  ano- 
dynes, stimulants,  external 
warmth,  etc. 

Evacuate  stomach  by  use  of 
mustard  or  stomach  tube,  or 
if  vomiting  has  occurred  aid 
by  large  draughts  of  warm 
water;  sulphate  of  magnesium 
as  cathartic;  hot  fomentations 
to  loins;  demulcents;  stimu- 
lants and  anodynes  if  needed; 
warmth  and  friction  externally. 

k  glassful  of  milk  or  water 
immediately  to  dilute  poison; 
albumin;  dilute  solution  of  car- 
bonate of  potassium  or  sodium; 
demulcents,  anodynes,  stimu- 
lants. 

Dilute  solution  of  carbonate  of 
potassium  or  sodium.,  or  tannic 
add;  albumin;  demulcents; 
anodynes  and  stimulants  if 
necessary. 


INDEX  OF  DRUGS. 


OFFICIAL  DRUGS    AND    PREPARATIONS   ARE    GIVEN   THEIR   PHARMACOPCEIAL 

TITLES. 

(Doses  and  uses  are  adapted  from  the  author's  Tables  for  Doctor  and  Druggist,  by  permission 
of  the  publisher,  E.  G.  Swift,  Detroit.) 


Abbreviations : 


*  UnoflScial. 


Ac.       =  acid. 
Al.        =  alkaline. 
Insol.  =  insoluble. 


Misc.  =  miscible. 
N.  =  neutral. 
Part.    =  partly  soluble. 


SI.  sol.  =  slightly  soluble. 
V.  s.       =  very  soluble. 
Spar.      ==  sparingly  soluble. 


Page 

Drug. 

Reac- 
tion. 

Solubility  in 

Dose. 

LTses. 

in 
text. 

Water. 

Alcohol. 

Gm.  or  mil. 

90 

Acacia,    gum   Arabic 

2 

insol. 

Demulcent:     In  irrita- 

Mucilago      acacise, 

ac. 

Freely 

tion      in      digestive 

35% 

tract;    in    emulsions 

Syrupus,  10% 

ac. 

Freely 

to  hold  oil  or  other 
matter  in  suspension 

143 

Acetanilidum,     anti- 

N. 

190 

3.4 

gr.  1-5 

0.06-0.30 

Antipyretic,    Anodyne: 

240 

febrin 

In    acute   fevers    cau- 

*Pulvis    acetanilidi 

gr.  2-15 

0.12-1 

tiously;      in      head- 

compositus 

aches;  locally  in 
powder  as  antiseptic. 

161 

*Acetozone,    benzoyl- 
acetyl        peroxide, 
benzozone 

si.  sol. 

gr.  1-5 

0.06-0.30 

Antiseptic;  bleaching 
agent. 

240     Acetphenetidinum, 

1310 

15 

gr.  2-10 

0.12-0.60 

Antipyretic,    Anodyne: 

phenacetin 

In  headaches. 

Acidum        aceticum, 

ac. 

local 

Solvent:  To  soften  cal- 

36% 

use 

lous     tissue,     corns, 

Acidum  aceticum  dil- 

ac. 

mi5-60 

1-4 

etc;  hemostatic. 

utum,  6% 

73 

Acidum  aceticum  gla- 
ciale,  99% 

ac. 

Caustic. 

241 

*Acid,   acetylsalicylic, 

aspirin 
Acid,    arsenous;    see 
Arseni  trioxid 

ac. 

300 

3 

gr.  5-20 

0.30-1.30 

Anodyne,  Antipyretic: 
In  rheumatism,  head- 
aches. 

134 

Acidum  benzoicum 

ac. 

275 

2.3 

] 

Antiseptic:     The  acid 

Ammonii  benzoas 

N. 

10 

35.5 

gr.  5-20 

0.30-1.30 

and  its  combinations 

*Lithii  benzoas 

si.  ac. 

3 

13 

given   internally    as 

Sodii  benzoas 

N. 

1.8 

61 

urinary  antiseptics. 

126  1  Acidum         boricum. 

si.  ac. 

18 

18 

gr.  5-15 

0.30-1 

Antiseptic:    Saturated 

boric  acid 

aqueous  solution  as 

120 

Sodii    boras,    borax 

al. 

15 

insol. 

gr.  5-20 

0.30-1.30 

mouth    wash    or    to 

126 

i     purulent    inflamma- 

126 

Glyceritum       boro- 
glycerini  (a  soln.  of 
boroglycerin,  31% 

N. 

local  use 

tions;  borax  has  sim- 
ilar uses,  is  alkaline 
and  antiseptic. 

boric  acid) 

j* Acidum  oapiphoric 

ac. 

125 

sol. 

gr.  10-30 

0.60-2 

To       control      night- 

1  Acid,     carbolic;     see 

. 

sweats  of  phthisis. 

Phenol 

Acid,     chromic;     see 

Chromii  trioxid 

" 

133 

*Acid,  cinnamic 

ac. 

si.  sol. 

sol. 

j  Antiseptic:    Similar  to 

1    benzoic  acid. 

230 

Acidum  citricum 

ac. 

0.5 

1.8 

gr.  5-20 

0 .  30-1 .  30   i  Restorative   tonic:       In 

i  Syrupus  acidi  citrici, 

f3l-4 

4-15        1     scurvy,  as  a  substi- 

1% 

;     tute  for  lemon-juice. 

108  ,  Acidum  gallioum 

1 

ac. 

87 

5 

gr.  5-20 

0 .  30-1 .  30     Astringent:  as  system- 
ic hemostatic. 

71  j  Acidum  hydrochlori- 

ac! 

.....        :  Caustic. 

291 

cum,  32% 

298 


INDEX  OF  DRUGS 


Page 

Solubility  in 

Dose. 

Drug. 

Reac- 
tion. 

Uses. 

in 

text. 

Water. 

Alcohol. 

Gm.  or  mil. 

229 

Acidum  hydrochlori- 
cum  dilutum,  10% 

ac. 

m5-20 

0.30-1.20 

Digestant:  when  acid- 
ity of  gastric  juice 
is  deficient. 

228 

Acidum   hydrocyani- 

ac. 

mi-3 

0.06-0.20 

Sedative:  in  cough  and 

239 

cum   dilutum,    dil. 

vomiting;    use    with 

291 

prussic  acid,  2% 

caution. 

73 

Acidum  lacticum,  85- 

90% 
Acid,     muriatic;    see 

Acid    hydrochloric 

ac. 

sol. 

sol. 

mi5-60 

1-4 

Antiseptic;  Solvent: 
Applied  to  diphther- 
itic   membrane    and 
in    pyorrhea    alveo- 
laris. 

71 

Acidum  nitricum. 

ac. 

Caustic:       Locally    to 

291 

aqua  fortis,  68% 

sloughing  ulcers,  and 

229 

Acidum  nitricum  dil- 
utum, 10% 

ac. 

m5-20 

0.30-1.20 

caries  of  bone;  dilute 
acid     as    tonic    and 

71 

Acidum    nitrohydro- 
chloricum,  aqua 

ac. 

stimulant  to  liver  and 
digestive   secretions. 

230 

regia 
Acidum    nitrohydro- 
chloricum  dilutum 

ac. 

m5-20 

0.30-1.20 

Tonic;  Digestant: 
Same  uses  as  dilute 
hydrochloric  and  ni- 
tric acids. 

Acidum  oleicum 

si.  ac. 

insol. 

sol. 

extern. 

To  prepare  oleates. 

291 

*Acid,  oxalic 

Acidum      phosphori- 
cum,  86% 

ac. 
ac. 

8 

2.5 

Irritant  poison:  As 
reagent;  to  remove 
stain  of  potassium 
permanganate,  or  of 
rust,  fruits  and  ink. 

231 

Acidum      phosphori- 
cum  dilutum,  10% 

ac. 

m5-30 

0.30-2 

Restorative  tonic:  In 
neurasthenia. 

*Acid,    picric,    carba- 

ac. 

86 

sol. 

Reagent;     Coloring 

zotic  acid 

agent. 

134 

Acidum  salicylicum 
♦Ointment,  10% 

ac. 

460 

2.7 

gr.  5-20 

0.30-1.30 
extern. 

Antiseptic;  Antipyre- 
tic: As  preservative; 

Ammonii  salicylas 

N. 

i' 

'3' 

gr.'  5-i5 

0.30-1 

salicylates   in    acute 

135 

Sodii  salicylas 

si.  ac. 

0.9 

9.2 

gr.  5-30 

0.30-2 

rheumatism. 

Strontii  salicylas 

19 

61 

gr.  5-30 

0.30-2 

71 

Acidum  sulphuricum, 

ac. 

Corrosive:    Dilute  acid 

291 

94% 

as  astringent. 

230 

Acidum  sulphuricum 
dilutum,  10%, 

ac. 

m5-20 

0.30-1.20 

[ 

The  aromatic  acid  as 

230 

Acidum  sulphuricum 
aromaticum 

ni5-20 

0.30-1.20 

solvent  for  quinine- 
sulphate. 

162 

Acidum         sulphuro- 
sum,    6%    of    sul- 
phur dioxide  gas 

ac. 

f3^-2 

2-8 

Disinfectant;  Bleach- 
ing agent:  In  para- 
sitic   skin    diseases; 

162 

*Sodii  bisulphis 

ac. 

3.5 

70 

internally  in  form  of 

Sod.   sulphis    exsic- 

N. 

2 

si.  sol. 

gr.  5-30 

0.30-2 

sulphites     or     thio- 

cat. 

1 

sulphate,  as  antisep- 

147 

Sodii  thiosulphas 

N. 

0.5 

insol. 

tic. 

163 

(hyposulphite) 

96 

Acidum  tannicum 

ac. 

0.33 

0.22 

gr.  1-30 

0.06-2 

Astringent:  Applied  as 

114 

*CoIlodium    stypti- 
cum,  20% 

local  use 

hemostatic;  to  con- 
tract   tissue    as    in 

93 

Glyceritum      acidi 

tannic,  20% 
Unguentum,  20% 
Trochisci 

local  use 

local  use 
gr.  1  each 

catarrhal  pharyngi- 
tis, and  to  check 
secretion,  as  in  diar- 
rhea. 

230 

Acidum  tartaricum 

ac. 

6!75 

3:3 

gr.  5-20 

0.30-1.30 

Substitute  for  citric 
acid  or  lemon-juice. 

73 

Acidum  trichloraceti- 
cum 

ac. 

V.  s. 

V.  8. 

Caustic:  Test  for  albu- 
min. 

239 

Aconitum,     aconite 

gr.  i-1 

0.15-0.06 

Cardiac  sedative:      To 

291 

root   (a.  napellus) 

reduce  arterial  pres- 

Plate 

Extract 

gr.  Vio-i 

0.006-0.015 

sure  in  inflammation 

xiv 

Fluidextractum 
aconiti 

mi-1 

0.15-0.06 

and  sthenic  fevers; 
locally    sedative    in 

64,65 

Tinctura  aconiti, 
10% 

m5-i5 

0.30-1 

form  of  plaster,  tinc- 
ture, or  the  oleate  of 

291 

Aconitina,  aconitia 
♦Oleate  of  aconitine, 

2% 
Actol;     see     Argenti 

lactas 

al. 

3200 

22 

gr.  '/400 
local  use 

0.00015 

aconitine,  in  neural- 
gia. 

91 

Adeps,  lard 
Adeps,  benzoinatus 

extern. 

As  basis  for  oint- 
ments; benzoinated 
lard  keeps  better 
than  ordinary. 

INDEX  OF  DRUGS 


299 


Page 

Drug. 

Reac- 
tion. 

Solubility  in 

Dose. 

Uses. 

in 

text. 

Water. 

Alcohol. 

Gm.  or  mil. ! 

91 

Adeps   lanae,   lanolin 
(purified      fat      of 
sheep's  wool) 

Adeps     1.     hydrosus, 
hydrous    wool-fat, 
contains  about 
30%  of  water 

misc. 

spar. 

extern. 

Lanolin  has  advan- 
tage of  being  able  to 
hold  an  aqueous  sol- 
ution. 

107 

*Adrenalin 

(claimed  to  be  the 
crystalline     active 

'  Chiefly 
\    local  use 

Preparations  from  the 
adrenals  are  arterial 
stimulants      injected 

principle  of  supra- 

' 

intravenously,      and 

renal  glands) 

hemostatics      locally; 

♦Adrenalin    chloride 

to    constrict    arteri- 

107 

♦Epinephrine    (alka- 
loid obtained  from 
suprarenal  glands) 

oles,  solutions  of  ac- 
tive principle,  1:1000 
to  1:3000,  are  ap- 
plied; the  chloride  is 
mostly  used. 

202 

iGther,  ethylic  ether, 

N. 

12 

misc. 

m5-30 

0.30-2 

Anesthetic;  Local  irri- 

Plate 

96% 

tant:      Stimulant  by 

vi 

Spirit  us  aetheris, 
32.5% 

N. 

f3i-l 

1-4 

reflex  irritation;  the 
spirits  used  for  stim- 

220 

=^Spiritus  setheris 
compositus ;    Hoff- 

f3i-l 

1-4 

ulating  and  anodyne 
effects. 

man 's  anodyne 

*jEther,  nitrous 

250 

Spiritus  aetheris  ni- 

N.t 

f3i-i 

1-4 

Diuretic;    Diaphoretic: 

251 

trosi,    sweet   spirit 
of  nitre 

or  ac. 

In  fevers  and  in  ne- 
phritis. 

165 

jEthylis      chloridum 

si.  sol. 

V.  s. 

Anesthetic;    Analgesic: 

208 

ethyl  chloride 

♦Agaric,      spunk      (a 

fungus) 
Albolene;  see  Petrola- 
tum _ 

local  use 

Used  locally  as  freez- 
ing agent. 
Absorbent;  Hemostatic. 

♦Albumin 

al. 

sol. 

insol. 

Freely 

Demulcent;      Antidote; 

98 

Alcohol,    ethyl   alco- 

N. 

misc. 

Solvent;      Preservative; 

131 

hol,  94.9%  by  vol. 

Antiseptic:      Locally 

Plate 

irritating  to  mucous 

viii 

1     membranes    accord- 

98 

Dehydratum,  99% 

N. 

ing  to  concentration; 

98 

Dilutum,  49%, 

N. 

f31-8 

4-30 

internally  stimulant 

98 

♦Spiritus   frumenti, 
whisky,    44-55% 

N. 

f3l-8 

4-30 

but  in  large  doses  is 
sedative. 

98 

♦Spiritus  vini  gallici, 
brandy,  46-55%, 

N. 

f3i-8 

4-30 

100 

♦Alcohol,  methyl, 
wood  alcohol 

N. 

misc. 

Solvent;  Antiseptic: 
Not  used  internally; 
fumes    have    caused 
blindness.     Poison. 

Plate 

Aloe,    aloes    (inspis- 

sol. in 

gr.  1-10 

0.06-0.60 

Bitter  tonic;  Cathartic; 

xviii 

sated  juice  of 

leaves) 

boiling 
water 

Emmenagogue:  In 
habitual       constipa- 

♦Extractum aloes 

gr.  1-3 

0.03-0.20 

tion;  in  hemorrhoids 

Pilulae  aloes 

1-4  pills 

not    due    to    active 

♦Pilulee  a.  et  ferri 

1-4  pills 

congestion;  in  amen- 

Tinctura 

f3J-l 

1-4 

orrhea,  anemia, 
chlorosis. 

Plate 

Aloinum,  aloin  (from 

N. 

65 

sol. 

gr.  i-1 

0.015-0.06 

Cathartic. 

xviii 

aloes) 

V.  s.  in 
boiling 
water 

102 

Alumen,  alum,  alum- 
inum  and   potass, 
sulphate  or  alumi- 
num   and    ammo- 
nium sulphate 

ac. 

7.2 

insol. 

gr.  5-30 

0.30-2 

1  Astringent:  Gargle  or 
wash;  to  check  su- 
perficial hemorrhage ; 
large  dose  emetic. 

80 

Alumen    exsiccatum. 

ac. 

20 

insol. 

local  use 

Astringent;   Caustic: 

103 

dried  alum 

Applied  to  excessive 
granulations. 

220 

♦Ammonia,  a  gas 

al. 

sol. 

sol. 

Aqua     ammoniae,     a 

al.  - 

mio-30 

0.60-2 

Stimulant:    Inhaled  in 

10%     solution     of 

syncope;  solvent. 

the  gas  in  water 

t  Spiritus  aetheris  nitrosi  easily  becomes  acid,  and  is  usually  so  as  found  in  the  stores. 


300 


INDEX  OF  DRUGS 


Page 

Drug. 

Reac- 
tion. 

Solubility  in 

Dose. 

Uses. 

in 

text. 

Water. 

Alcohol 

Gm.  or  mil. 

73 

Aqua  ammoniiB 

al. 

Aq.   ammonise   fortior 

291 

fortior,  28% 
Linimentum,  25% 

extern. 

is  caustic. 

*Spiritus  ammonise, 

ai 

mi6-3o 

0.60-2  1 

10% 

't 

Internally    as    stimu- 

216 

Spiritus     ammonise 

al. 

f3i-l 

1-4       J 

lant. 

220 

aromaticus 

Liquor  ammonii 

ac. 

fSM 

8-30 

Diaphoretic  in  fevers. 

acetatis 

Ammonii  benzoas 

N. 

10 

35 

gr.  5-30 

0 .  30-2      1  Same  as  benzoic  acid. 

Plate 

Ammonii  bromidum 

N. 

1.3 

12 

gr.  5-30 

0.30-2 

Sedative:     In  epilepsy, 

XV 

whooping-cough. 

220 

Ammonii  carbonas 

al. 

4 

t 

gr.  2-10 

0.12-0.60 

Stimulant;  Expector- 
ant: In  pneumonia, 
typhoid  conditions. 

Ammonii  chloridum 

N. 

2.6 

100 

gr.  2-10 

0.12-0.60 

Expectorant    in    bron- 

Trochisci    anmionii 

If    gr.    in 

chitis;     alterative    in 

chloridi 

each 

myalgia. 

Ammonii  iodidum 

N. 

0.6 

3.7 

gr.  2-10 

0.12-0.60 

Alterative  in  syphilis, 
scrofula. 

♦Ammonii  nitras 

N. 

0.5 

20 

To  prepare  nitrous 
oxide. 

Ammonii  valeras 

ac. 

V.  8. 

V.  a. 

gr.  5-15 

0.30-1 

Stim,ulant  in  hysteria 

♦Amygdala  amara, 

Nerve  sedative  in  cough 

bitter  almond  seeds 

and    vomiting;    the 

Oleum    amygdalae 

N. 

300 

sol. 

mi-i 

0.01-0.03        preparations  of  bit- 

amarffi 

j     ter   almond   contain 

Spiritus,  1%  oil 

N. 

ms-io 

0.30-0.60  :     hydrocyanic  acid  in 

Amygdala    dulcis. 

sm.all  amount. 

sweet  almond  seeds 

i 

Emulsion  amygdalae 

Freely 

As  vehicle. 

Oleum    amygdalae 

f3l-4 

4-15         1  Demulcent. 

expressum 

225 

Amylis  nitris,  nitrite 

N. 

insol. 

misc. 

mi-5 

0.06-0.30 

Inhaled  in  angina  pec- 

Plate 

of  amyl 

toris,     asthma,     hic- 

xiii 

cough,  epilepsy. 

'294 

Amylum,  starch 

Glyceritum  amyli 
♦Anesthesin 
Animal  charcoal;  see 
Carbo 

Freely 

Demulcent:        Dusting 

powder. 
Demulcent. 
Local  analgesic. 

Anisum,  anise  seed 

gr.  10-30 

0.60-2 

Aromatic,  Carminative: 

Aqua  anisi 

N. 

f5i-l 

8-30 

In  colic. 

Oleum 

N. 

l' 

mi-5 

0. 06-0. 30 

Flavoring  agent. 

Spiritus 

f3i-l 

1-4 

251 

Antimonii  et  potassii 

si.  ac. 

12 

insol. 

/    gr.  i-2   , 
I  gr.  Vij-1 

0.03-0.12 

Emetic. 

tartras,  tartar  eme- 

0.005 

Sedative;    Expectorant: 

tic 

Depresses  heart. 

♦Vinum  antimonii 

m5-60 

0.30^ 

Expectorant. 

107 

Antipyrina,  phena- 

N. 

i' 

i'3 

gr.  2-10 

0.12-0.60 

Antipyretic    in     acute 

240 

zone 
*Antisei3tol ;    see    cin- 
chonine       iodosul- 
phate 

fevers;  anodyne  in 
neuralgias,  migraine, 
myalgia,  pertussis, 
infantile  convulsions; 

54 

♦Antitoxin,    a    serum 
that  is  antidotal  to 
the  toxin  of  a  cer-  | 
tain  disease;   as  an  , 
example,  see  Serum 
antidiphthericum 

[ 
t 

hemostatic  locally  to 
check  capillary  hem- 
orrhages. 

252     ApomorphinsB  hydro- 

N. 

40 

50 

gr.  i/io-i/io 

0.003-0.006 

Emetic:      Hypodermi- 

chloridum       (from  [ 

cally     when  patient 

morphine) 

cannot  swallow,  as 
in   opium   narcosis. 

148   *Argentum,   silver,    a 

Silver  salts  are  astrin- 

i      metal 

gent   and    antiseptic; 

149    *Argenti  citras,  itrol     ' 

si.  sol. 

extern. 

1 

a  form  of  metallic  sil- 

149   *Argenti  lactas,  actol 

20 

extern. 

1 

ver  soluble  in  water. 

78     Argenti  nitras 

N. 

0.4 

30 

gr.  i-J 

0.01-0.03 

also   citrate,   lactate 

103 

and  nitrate  are  used 

148  i 

as  antiseptics;  nitrate 

78   *Argenti  nitras  dilutus, 

N. 

sol. 

sol. 

as      astringent;       in 

mitigated    caustic, 

chronic      dysentery; 

33  h%                        i 

diarrhea   of   typhoid 

78  :  Argenti  nitras  fusus, 

N. 

sol. 

sol. 

fever;  to  check  car- 

lunar caustic,  96% 

ies  in  temporary 
teeth;  also  as  caws^if; 
locally  to  abort  in- 
flammation. 

t  Decomposition  occurs. 


INDEX  OF  DRUGS 


301 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Uses. 


Water.  1  Alcohol 


Gm.  or  mil. 


N. 


Argenti  oxidum  '     al.     ]  si.  sol. 

Aristol;  see  Thymolisj  [ 

iodidum 

Arnica  (flowers) 

Tinctura  arnicse 

82     Arseni  trioxidum,  =i   „/.     i^    ^^ 

232         arsenic  ®^-  ^°-    I  100 

291   i     Liquor  acidi  arsen- 

osi,  1% 

Liquor  potassLi  arsen- 

itis,  Fowler's  sol. 

Liquor  sodii  arsena- 

tis,  1% 
(Pearson's  sol.  Vio  as 
strong  as  above) 


232  Liquor  arseni  et  I 
hydrargyri  iodidi,  j 
Donovan's  solution 
*Solution  of  potas- 1 
slum  arsenate  and 
bromide,  Clemen's 
solution 
Arseni  iodidum  N. 

Sodii  arsenas  iN.oral: 

Salvarsan  I     N. 

Neosalvarsan   _  N.     I 

Sodium    arsanilate, !      . .     I 
atoxyl  _     I  ' 

Sodii   arsenas   exsic-  j     al. 

catus  I 

Sodii  cacodylas 
Asafetida;     a     gum- 
resin 
Emulsum  asafetid», 

milk  of  asafetida 
Pilulae  asafetidae 


insol. 


si.  sol. 


gr.  4-2 


mi5-45 

gr.  Veo-Vio 

m2-io 


0 .  03-0 .  12     In  nervous  diseases. 


1-3 

0.001-O.006i 

0.12-0.60 


m2-10         0.12-0.60 
m2-10         0.12-0.60 


12 
12 
10 

V.  s. 


28 

si.  sol. 

12 


m2-8 


m2-io 


gr.  Vso-'/io 

gr.  Vao-Vio 

gr.  1-8 

gr.  2-10 

gr.  8 


0.12-0.. 50 


0.002-0.006 

0.002-0. 0061 

0.05-0.50  , 

0.12-0.60 

I         0.5 


As  a  liniment. 

Escharotic:  lias  slow 
but  powerful  action; 
to  devitalize  pulps 
of  teeth;  in  small 
doses  alterative  tonic; 
to  improve  the  nu- 
trition in  anemia, 
chorea,  chronic  dis- 
eases of  the  skin; 
antiperiodic  in  ma- 
larial fever. 

Donovan's  solution  as 
a  combination  of 
alteratives  is  used  in 
syphilitic  and  tuber- 
culous (scrofulous) 
conditions;  sod.  ca- 
codylate  and  arsani- 
late are  less  toxic 
salts  of  arsenic;  sal- 
varsan is  largely 
used  in  early  stages 
of  syphilis. 


3.1       si.  sol.      gr.  i/eo-Vio  iO. 001-0. 006i 


Tinctura 
*Aseptol,  a33|% 

solution   of   ortho- 
phenolsulphonic 
acid 
Aspidium,  male  fern 
(root) 
Oleoresina  aspidii 
Aspirin;  see  Acid, 
Plate         acetylsalicylic 
ix        Atropina,  from  bella- 
222  ,       donna 
291  i     Atropinse  sulphas 
Homatropinse    hy- 
drobromidum 


Aurantii   amari   cor- 
tex, bitter  orange- 
peel 
Fluidextractum 
aurantii  amari 
Tinctura 
Aurantii  dulcis   cor- 
tex, sweet  orange- 
peel 
Oleum  aurantii 
Syrupus  aurantii 
Spiritus  a.  comp. 
Tinctura  a.  dulcis 
*Aurantii  flores, 
orange  flowers 
Aqua  aur.  florum 
Aqua  a.  fl.  fortior 
Syrupus  a.  florimi 


part 


sol. 


2.5 
part 


sol. 


gr.  4-3 
gr.1-8 

f54-l 

3  gr.  in 
each 
f34-l 


0.03-0.20 
0.06-0.50 


15-30 


al. 


N. 
N. 


455 


0.4 
6 


insol. 


5 
40 


34-2 

gr.  1/120-V60 

gr.  Vi2ff-^/6o 
gr.  Vi!0-'/6o 


2-8 
1-2 


Stimulant;  Laxative: 
As  antispasmodic  in 
hysteria,  chorea  and 
other  nerv-ous  spas- 
modic conditions;  in 
flatulent  colic. 

Antiseptic:    Locally  in 
dilute    solution. 


Anthelmintic:     To  de- 
stroy tapeworm. 


f3i-4 
f3l-2 


mi-5 

Freely 


0005-0.001  Stimulant;  Mydriatic: 
To  dilate  pupil  and 
.0005-0.001  paralyze  accommo- 
.0005-0.001!  dation;  to  relieve 
peripheral  irritation, 
cough,  asthma,  etc.; 
as  respiratory  stimu- 
lant in  opium  poison- 
ing; homatropine  is  a 
more  transient  myd- 
riatic. 
Bitter  tonic:  Carmina- 
tive ;  preparations 
used  chiefly  as 
vehicles. 


1-2 
4-8 


0.06-0.30 


Preparatio'ns  as  flav- 
oring agents  and 
vehicles. 

Flavoring  agent. 

As  vehicles. 


Flavoring  agents. 


As  vehicle. 


302 


INDEX  OF  DRUGS 


Page 

in    I 
text.  1 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Uses. 


Water.  Alcohol. 


Gm.  or  mil. 


N. 


134 


222 
Plate 


291 


*01eum    a.    florum 
oil  of  neroli 
*Aurum,  gold 
Auri   et   sodii   ohlor-   si.  ac. 

idum 
*Aurum  bromide 
*Aurum  chloride 
♦Solution     of     gold 
and    arsenic    bro- 
mide, "arsenauro" 
♦Solution    of    gold, 
arsenic    and    mer- 
cury bromide 
"mercauro" 
Balsam    of    copaiba; 

see  Copaiba 
Balsamum       Peruvi- 

anum 

Balsamum  tolutanum 

Syrupus  tolutanus 

Tinctura  tolutana 

Basham's  mixture; 

see   under   Ferrum 
Bearberry;     see  Uva 

ursi 
Belladonnse  folia, 
deadly  night-shade 
(leaves) 
Extractum  bella- 
donnse  foliorum 
Emplastrum 
Tinctura  bella- 

donnse  foliorum 
Unguentum  bella- 
donnse; 
Belladonnse  radix 
(root) 
Fluidextractum  bel- 

ladonnse  radicis 
Linimentum     bella- 
donnae; 
see  Atropine 

Benzinum  (from 

petroleum) 
Benzoinum 
Tinctura  benzoini 
Tinctura  benzoini 
composita,    Friar's 
balsam 


i*Benzol    (from     coal- 
'       tar) 

*Benzosol,       guaiacol 
benzoate 

266     Benzosulphinidum, 
285         saccharin    (a   coal- 

I       tar  product) 
145  '  Betanaphtol,  naphtol 
179      Betaeucainse    hydro- 
182         chloridum,  eucaine 


133 


♦Bismuth;  a  metal 
Bismuthi    subcar- 

bonas 
Bismuthi  subnitras 
Magma  bismuthi, 
milk  of  bismuth 
♦Bismuth      oxyiodide 
(subiodide) 
Bismuthi    subgallas, 
dermatol 


insol. 


sol. 


insol. 


N. 

N. 


si.  ac. 

N. 


insol. 


290 


1000 
30 


insol. 
insol. 


insol. 
insol. 


1 
part 
sol. 


sol. 


sol. 


0.8 
35 


insol. 
insol. 

insol. 
insol. 


Perfume. 


gr.  1/30-1/ 10  0. 002-0. 00e>  Alterative:      In   syph- 
ilis, action  similar  to 
gr.  Vioo-Vio  0.0006-0.006 
gr.  i/eo-'/so    0.001-0.002 


m5-15 


m5-15 


mio-30 

f3§-l 


extern. 
m5-15 

extern. 

gr.  1-2 

ini-2 

extern. 


gr.  5-30 
TU5-60 
m5-60 


gr.  2-10 
gr.  1-5 


gr.  2-10 
gr-  i-i 


gr.  5-20 

gr.  5-20 
iZi-2 

gr.  5-10 

gr.  5-15 


0.30-1 


0.30-1 


0.60-2 
8-30 
2-4 


bichloride  of  mer- 
cury; in  sclerosis  of 
liver  and  kidneys, 
impotence,  amenor- 
rhea, nervous  disor- 
ders, diabetes;  the 
bromide  in  epilepsy; 
the  chloride  recom- 
mended in  tubercu- 
lous disorders. 

In  scabies. 

Stimulant;  expectorant. 
As  vehicle. 
As  vehicle. 


Mydriatic:  Atropine  to 
dilate  pupil. 


0.0075-0.03  Attodyne:       To    quiet 
peripheral  pain  and 
irritation;  in  asthma, 
0.30-1  nen'ous   cough,   irri- 

I  table  bladder,  incon- 
tinence of  urine; 
combined  with  ca- 
0.06-0.12  thartics  to  prevent 
griping;  in  small 
0.06-0.12  doses  stimulant  to 
the  heart  and  respi- 
ration; in  opium 
poisoning;  vasomotor 
stimulant;  to  check 
sweating. 
Solvent. 


gr.  1-2         0.06-0.12 


0.30-2 
0.30-4 
0.30-4 


To  prepare  benzoic 
acid;  Antiseptic. 
Tinctures  inhaled  in 
respiratory  diseases 
and  applied  as  local 
stimulants  and  anti- 
septics to  mucous 
membranes. 

Solvent. 


0.12-0.60 


0.06-0.30 


0.12-0.60 
0.015-0.03 


0.30-1.30 
2-8 


Antiseptic:  In  intes- 
tinal diseases  and 
phthisis. 
Sweetening  agent:  Is 
500  times  sweeter 
than  cane-sugar. 
Antiseptic. 

Local  analgesic:     Less 
powerful    and    toxic 
I     but  more  irritating, 
I     than  cocaine. 
0.30-1.30  !  Locally     sedative    and 
slightly     astringent; 
in     vomiting,     diar- 
rhea, gastric  ulcer. 


0.30-0.60 
0.30-1 


Antiseptic  to  dress 
wounds  and  ulcers. 

Antiseptic:  As  substi- 
tute _  for  iodoform; 
also  internally. 


INDEX  OF  DRUGS 


303 


142 
291 


251 


Drug. 


Reac- 
tion. 


Solubility  in 


Water.  Alcohol 


177 

216 

223 

Plate 


117 
223 


227 


142 
160 


90 
119 


121 


*Bismuth  tribromphe- 
nolate,  seroform 

Bisulphide  of  carbon; 
see  Carbonei  disul- 
phidum 

Bitter  almond;  see 
Amygdala  amara 

Bitter  orange  peel; 
see  Aurantii 

Blackberry;  see  Ru- 
bus 

Black  haw;  see  Vibur- 
num prunif  olium 

Black  wash 

Blue  ointment 

Blue  pill; 

see  under  Hydrar- 
gyrum 

Borax;  see  Sodii boras 

Brandy;  see  under 
Alcohol 

Bromoformum 

Bromum,  bromine 

Brown   mixture;   see 

under  Glycyrrhiza 
Buohu  (leaves) 
Fluidextractum 

buchu 
Buckthorn;  see  Fran- 

gula 
Cacao     butter;      see 

under  Theobroma 
^'Caffea   (C.   arabica), 

coffee  (seeds) 
Cafleina,  caffeine 

(theine) 
Caffeina  oitrata,  50% 

caffeine 
Caffeina  citrata  effer- 

vescens,    2%    caf- 
feine 
Caffeinae      sodioben- 

zoas 
Cajuput,   oil  of;   see 

Oleum  cajuputi 
Calcium;    see    under 

Calx 
Calomel;    see    under 

Hydrargyrum 
Calumba  (Jateorhiza 

palmata),  columbo 

(root) 
Tinctura 
Calx,  lime 
Calx  chlorinata, 

bleaching   powder, 

chloride  of  lime 
Calcii  sulphidum  cru- 

dum 
Linimentum    calcis, 

carron  oil 
Liquor  calcis,  lime- 
water 


*SyTupus  calcis 

*Calcium,  a  metal 

Calcii  bromidum 


Calcii  carbonas 
prsecipitatus 

Cretse  prseparata, 
prepared  chalk 

Mistura  cretse 

Pulvis  cretse 
compositus 


insol.      insol 


Gm.  or  mil. 


Uses. 


300 

28 


al. 


N.  or 
al. 


sol. 
sol. 


sol. 
sol. 


1.1 


840 
part 


si.  sol. 


0.7 


aim. 
insol. 


mi-5 

extern. 


gr.  15-60 
mi5-60 


0.06-0.30 


66 
sol. 
sol. 

30 


insol. 
part 


insol. 


1.3 
insol. 


gr.  1-5 

gr.  2-10 

3i-2 

gr.  2-10 


gr.  5-30 
f31-2 


gr.  i/i»-l 


f31-8 


mi5-60 
gr.  5-30 


gr.  5-30 

f32-8 
gr.  5-60 


1-4 
1-4 


0.06-0.30 

0.12-0.60 

2-8 

0.12-0.60 


0.30-2 

4-8 


Antiseptic:     Has  been 
used  in  root  filling. 


0.006-0.06 


4^30 


1-4 
0.30-2 


0.30-2 


8-30 
0.30-4 


Anesthetic:  recom- 

mended in  pertussis. 

Caustic;  Reagent;  Anti- 
septic. 

Stimulant;  diuretic;  in 
inflammation  of  the 
genito-urinary  tract. 


Stimulant;  Diuretic; 
Stimulates  cerebrum 
and  heart;  in  opiiom 
poisoning  strong  in- 
fusion or  decoction 
by  enema  or  caffeine 
hypodermically ;  in 
headaches,  cardiac 
failure. 


Bitter  tonic:  In  atonic 
indigestion;  it  con- 
tains no  tannin. 

Caustic. 
Disinfectant. 


To    prevent   suppura- 
tion. 
Externally  to  b\irns. 

Alkali:  In  vomiting, 
diarrhea;  to  correct 
acidity  and  irritabil- 
ity of  stomach;  anti- 
dote to  oxalic  acid. 

Sedative:  Same  use  as 
sodiima  bromide. 

Preparations  of  the 
carbonate  are  used 
in  indigestion,  vom- 
iting, and  diarrhea; 
prepared  chalk  as 
an  antacid  to  the 
mouth  and  in  den- 
tifrices. 


304 


INDEX  OF  DRUGS 


Solubility  in 

Dose. 

p?ge 

Drug. 

Reac- 
tion. 

Uses. 

in 

text. 

Water. 

Alcohol 

Gm.  or  mil. 

Ill 

Calcii  chloridum 

N. 

1.2 

10           gr.  5-10 

0.30-0.60 

Alterative:      Hemosta- 

Calcii lactas 

20 

aim.          gr.  5-10 
insol. 

0.30-0.60 

tic;  Chloride  and 
lactate  internally  in 

hemorrhages. 

Calcii    hypophosphis 

N. 

6.5 

insol. 

gr.  2-10 

0.12-0.60 

Tonic;  Alterative:  _    In 

*Syrup 

f31-3 

4-12 

anemia,  rhachitis, 
caries. 

231 

Syrupus     hypophos- 
phitum 

f31-3 

4-12 

Syrups  of  hypophos- 
phites     in     wasting 

231 

*Syrupus   hypophos- 
phitum  compositus 

f3i-3 

4-12 

diseases,  tuberculo- 
sis, rhachitis,  ner- 
vous diseases. 

Syrupus   calcii  lac- 

f31-3 

4-12 

Similar  uses  to  above. 

tophosphatis 

*Calcii  sulphas  exsic- 

N. 

378 

insol. 

Used   in    making   im- 

catus,    plaster     of 

pressions,   casts  and 

Paris 

plaster-of-Paris  ban- 
dages and  jackets. 

*Calcium  iodide 

0.5 

gr.  2-4 

0.12-0.25 

Alterative;  Antiseptic: 
In  pulmonary  syph- 
ilis. 

Cathartic:  In  dropsies. 

Cambogia,  Gamboge 

gr.  1-3 

0.06-0.20 

221 

Camphora,   camphor 

si.  sol. 

sol. 

gr.  1-5 

0.06-0.30 

Stimulant;      Anodyne: 

292 

To  relieve  spasm  or 

Aqua  camphorae 

f3l-4 

4-15 

cramp,       dysmenor- 

*Ceratum 

extern. 

rhea,    cholera,    colic, 

221 

Spiritus,  10% 

Linimentum     cam- 
phorae,     camphor- 
ated oil,  20% 

izi-l 

1-2 

diarrhea,  nervous 
depression,  head- 
ache, neuralgia;  spir- 
it inhaled  in  syncope; 
liniment    externally; 

*Acid    camphor    mix- 

f3l-4 

4-15 

in  diarrhea. 

ture,   Hope's  mix- 

ture 

Camphora  monobro- 

N. 

aim. 

6.5 

gr.  1-5 

0.06-0.30 

Monobromate  is  seda- 

mata 

insol. 

tive  to  nervous  sys- 
tem; in  insomnia 
and  hysteria. 

292 

Cannabis;   C.  sativa 
or    indica,    Indian 
hemp   (tops  of  fe- 
male plant) 

.... 

gr.  2-5 

0.12-0.30 

Anodyne;  Deliriant; 
Hypnotic:  In  mi- 
graine, neuralgia, 
dysmenorrhea,     irri- 

Extractum cannabis 

gr.  i-l 

0.01-0.03 

table  bladder,  reten- 

Fluidextractum 

mi-4 

0.06-0.25 

tion  of  urine;  in  tet- 

Tinctura 

m5-20 

0.30-1.20 

anus,  delirium  tre- 
mens, acute  mania. 

67 

Cantharis,      Spanish 

Vesicant:    To  produce 

292 

flies 

• 

blister  in   neuralgia, 

Ceratum      canthar- 

rheumatism;      coun- 

idis 

extern. 

teract   local    inflam- 

Collodium canthar- 

mations;        promote 

idatuni 

absorption  of  effu- 
sions. 

Tinctura      canthar- 

mi-4 

0.06-0.25 

Tincture  internally  is 

idis 

diuretic  and  irritant; 
use  cautiously;  ap- 
plied locally  diluted, 
to  stimulate  growth 
of  hair. 

61 

Capsicum  (C.  frutes- 
cens),  Cayenne 
pepper  (fruit) 

Emplastrum 

gr.  1-3 

0.06-0.20 
extern. 

Local  stimulant  and 
irritant:  To  stimu- 
late unhealthy  con- 
dition of  the  gums; 
in  atony  of  stomach, 

Oleoresina 

iiij-i 

0.01.5-0.06 

diarrhea,  colic,  indi- 

Tinctura 

ms-io 

0.30-0.60 

gestion  of  alcohol- 
ism; plaster  as  mild 
counterirritant. 

152 

*Carbo  animalis,  ani- 
mal charcoal 

♦Carbo  animalis  puri- 
ficatus 

Freely 

Decolorizing  agent. 

As  antidote  in  alka- 
loidal  poisoning;  to 
decolorize  and  purify 
liquids. 

Absorbent:     Internally 

152 

Carbo    ligni,     wood 

Freely 

charcoal 

in  flatulent  indiges- 
tion. 

INDEX  OF  DRUGS 


305 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water. 


Alcohol, 


Dose. 


Uses. 


Gm.  or  mil. ! 


139 
Plate 
xviii 


Carbonei      disulphi- 
dum 

Cardamomum,     car- 
damon  (seed) 
Tinctura   carda- 

momi 
Tinctura  c.  comp. 
*Carinine,       carminic 
acid     (from     coc- 
cus) 

Carron  oil;  see  under 
Calx 

Caryophyllus    (euge- 
nia   aromatioa), 
cloves  (flower  buds) 

Oleum     caryophylli 

Cascara         sagrada, 

rhamnus  purshiana 

(bark) 
Extractum   cascarae 


156 


245 

246 

Plate 

xvi 

292 


Fluidextractum 
Fluidextra^t,   arom. 
Cassia,    oil    of;    see 

under       Cinnamo- 

Tniim 
Castor  oil;  see  Oleum 

ricLui 
Catechu;  see  Gambir 
Cera  alba,  white  wax 

Ceratum 
Cera     flava,     yellow 

wax 
Cetaceum,     sperma- 
ceti 
Chalk,  prepared;  see 

under  Calcium 
Charcoal;   see  Carbo. 
*Chinosol,  quinosol 


Chloralum  hydratum, 
chloral 


*Butyl-chloral,  cro- 
ton-chloral 


*Chloral-camphor 
*Chloral-phenol 
*Chloral-menthol 
*Chloretone,  acetone- 
chloroform 
Chloride  of  lime;  see 
Calx  chlorinata 
142    *Chlorine;  a  gas 
142        Liquor  sodse  chlori- 


160 


142 
160 


natse,  Labarraque's 
solution,  2.5% 
chlorine 


Calx  chlorinata,         j     al. 
chloride     of    lime,  | 
30%  chlorine  I 


526 


sol. 


insol. 


sol. 


sol. 


gr.  10-15 
f3i-l 
f3§-2 


insol.      spar, 

insol.      spar. 

insol.       a_lm. 
insol. 


insol. 


0.25 


1.3 


insol. 
sol. 


sol. 
sol. 
sol. 

V.  s. 


mi-5 

3i-l 


gr.  1-5 


mio-30 

mi5-60 


extern, 
extern. 


part.       part. 


gr.  5-15 

gr.  5-15 

1 

\  extern. 

gr.  5-15 

f3i-i 


0.60-1 
1-4 
2-8 


gr.  2-10        0.12-0.60 


0.06-0.30 
1-4 


0.06-0.30 


0.60-2 
1-4 


0.30-1 


0.30-1 


0.30-1 


2-4 


Solvent  for  rubber. 

Aromatic:  As  flavor- 
ing agent  and  car- 
minative; in  flatu- 
lent colic. 

Coloring  agent.  " 


Aromatic:  As  condi- 
ment and  carmina- 
tive; the  oil  in  pre- 
paring microscopic 
specimens. 

Tonic  cathartic;  in 
chronic  constipation. 


In  cerates  and  oint- 
ments; as  impres- 
sion and  modelling 
material. 

In  cerates  and  oint- 
ments. 


Antiseptic:  For  treat- 
ing pus  cavities  (1  to 
2%  sol.) ;  internally 
as  intestinal  anti- 
septic. 

Hypnotic;  Sedative:  In 
insomnia,  mania,  te- 
tanus, convulsions  of 
children,  strychnine 
poisoning,  epilepsy, 
other  spasmodic 

affections,  deliriiim 
of  fevers,  cholera; 
use  cautiously. 

Croton-chloral,  simi- 
lar to  chloral  in  ac- 
tion, is  said  to  have 
a  special  anodyne 
effect  upon  the  fifth 
cranial  nerve. 

Locally  in  neuralgia 
as  anodyne  and  coun- 
terirritant. 

Hypnotic;  Analgesic. 


Antiseptic:  Externally 
as  disinfectant  wash ; 
bleaching  agent:  to 
bleach  discolored 
teeth. 

Disinfectant;  Bleaching 
agent. 


20 


306 


INDEX  OF  DRUGS 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water.  Alcohol 


Dose. 


Uses. 


Gm.  or  mil.  I 


205     Chloroformum  N. 

Plate       Aqua     chloroformi, 
vii    I       about  0.5% 
67  !     Linimentum,  30% 
292  1     Spiritus,  6% 

!       A    stronger    spirit 
I       (J    chloroform)    is 
I       known    as    chloric 
1       ether 
SO  I  Chromii     trioxidum, 
:       chromic  acid 
227  j  Cinchona,    Peruvian 
bark 
Cinchona  rubra 
Fluidextractum  cin- 

chonse 
Tinctura 

Tinctura    cinchonae 
composita; 
see  Quinina 
Cinchonidinse        sul-      N. 
phas 


210 


143 


Cinchoninse  sulphas 

*Cinchonine  iodosul- 
phate,  antiseptol 


Cinnamomum,      cin 

namon  (bark) 
*C.  cassia 
C.  saigonicum 
C.  zeylanicum 
Aqua  cinnamomi 
138  !     Oleum  cassise,  oil  of  I  si.  ac. 
cinnamomi 
Spiritus 
Tinctura 
Cloves ;     see     Caryo- 
phyllus 
88  j*Cobalt 

169    *Coca,      erythroxylon 
Plates!       coca  (leaves) 


63 


58 
insol. 


insol. 


sol. 


72 


10 


sol. 


169 

292 

Plates 

ii,  iii 


248 
294 


Cocaina  (from  ery- 
throxylon coca  and 
its  varieties) 
Cocainae  hydrochlori- 
dum 

*01eatum   cocainae,  ' 
5% 
Coccus,  cochineal  (an 
insect) ;  used  as  col- 
oring     agent;     see 
also  Carmine  ' 

Codeina      (alkaloid     I 
from  opium) 
Codeinse  phosphas 
Codeinae  sulphas        I 
Cod-liver      oil;      see 

Oleum  morrhuse 
Coffee;  see  Caffea 
Colchici  cormus 
(corm     of     colchi- 
cum  autumnale) 
Extraetum    colchici 
cormi 
Colchici  semen  (seed) 
Fluidextractum     col- 
chici seminis 
Tinctura  colchici 

seminis 
Colchicina  (alkaloid 
from  c.  autumnale) 
Cold  cream ;  see  under 
Rosa 


al. 

ac. 

N. 


600 
0.4 


6.5 
3.2 


120 


2.3 
30 


m2-io 

f5i-i 


f3^-2 


gr.  10-30 
gr.  10-30 

mio-30 

f3i-2 
f3l-2 

gr.  1-20 


gr.  1-20 
extern. 

gr.  1-10 


f5i-l 

mi-s 
mio-60 

m5-30 


extern. 

3i-i 


gr.  k-h 
locally 

gr.  i-1 


0.12-0.60  \  Anesthetic;     Anodyne: 
8-30        I     By  inhalation  most- 
I     ly;    in    convulsions, 
extern.  dysmenorrhea      and 

2-8  other  spasmodic 

pain;  locally  as  ano- 
dyne and  irritant; 
internally  in   colic. 

Caustic:        Local    use 
only. 

0.60-2  Bitter  astringent  tonic: 
in  atonic  indiges- 
0.60-2  tion,   relaxed   condi- 

0 .  60-2  tions      of       mucous 

membrane  of  diges- 
2-8  tive    tract;     general 

2-8  tonic;      antiperiodic; 

in  malarial  fevers, 
periodic  neuralgia. 
0.06-1.30  I  The  alkaloids  possess 
the  tonic  and  anti- 
malarial \'irtues  of 
cinchona;  in  medi- 
cinal value  they 
stand  in  the  follow- 
ing order: 
0.06-1.30  Quinine. 

Cinchonidine. 
Cinchonine. 
Antiseptic:     An  odor- 
less    substitute     for 
iodoform  (50% 
iodine) . 
0.06-0.60  \  Aromatic;  Condiment. 


8-30 
0.06-0.30 


0.60-2 
0.30-2 


As  vehicle. 

Flavoring  agent:    Used 

as     carminative     in 

flatulence;  antiseptic; 

spirit  and  tincture  as 

vehicle. 


325 
1280 

gr.  i-1 
gr.  i-1 

0.015-0.06 
0.015-0.06 

gr.  2-10 

0.12-0.60 

gr.  J-2 

0.03-0.12 

gr.  1-8 

mi-8 

0.06-0.50 
0.06-0.50 

m 10-60 

0.60-4 

V.  8. 

gr.  Via) 

0.0005 

Eschar  otic:  To  devital- 
ize pulps  of  teeth. 
1-4  Stimulant:     In  action 

similar  to  coffee; 
large  doses  are  seda- 
tive; the  alkaloid  co- 
caine is  a  local  anal- 
gesic,  stimulant   and 

0.01-0.03  mydriatic;  locally  or 
hypodermically  in  1 
to  4%  aqueous  solu- 
tion to  abolish  sen- 
sation; applied  to 
the  eye  it  dilates 
pupil;  use  cautiously 
to  avoid  poisoning  or 
habit. 

0.015-0.06  Same  use  as  opium; 
The  after-effects  are 
less  unpleasant;  in 
diabetes. 


Alterative:  In  full 
doses  diuretic  and 
cathartic;  its  chief 
use  is  in  subacute 
or  chronic  rheuma- 
tism and  in  rheuma- 
tic gout;  in  ascites 
due  to  hepatic  ob- 
struction; colchicine 
may  be  given  hypo- 
dermically. 


■j  Decomposition  occurs. 


INDEX  OF  DRUGS 


307 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Water.  .Alcohol. 


Gm.  or  mil. 


Uses. 


114     Collodium,   collodion 
11-i     Collodium  flexile, 
flexible  collodion 


67 


Plate 
xviii 


110 


130 
131 
131 


129 


91 
251 
252 


Collodiuni    canthari- 

datum 
*Collodiuni        stypti- 

cum,    20%    tannic 

acid 
Colocynthis     (citrul- 

lus  c,  fruit) 
Extractum         colo- 

cynthidis 
Extractum  c.    com- 

positum 
Pilulae       catharticse 

compositaef 
*Pilul£e       catharticse 

vegetabiles 
Columbo;  see  Calum- 

ba 
''Convallaria  (c.  maja- 

lis) ;  lily  of  the  val- 
ley (root) 
*Fluidextractum 

convallarise 
Copaiba,    balsam    of 

copaiba 
*01eum  copaibae 
Copperas ;    see    Ferri 

sulphas 
Copper      salts;      see 

under  Cuprum 
Corrosive  sublimate; 

see  under  Hydrar- 
gyrum 
Cotarninffi        hydro- 

chloridum       (from 

narcotine,  an 

opium  alkaloid) 
Cotton;   see  Gossyp- 

ium 
Cotton-seed    oil;    see 

under   Gossypium 
Cream  of  tartar;  see 

Potassii  bitartras 
Creosotum    (distilled 

from  wood) 
Aqua   creosoti,    1% 
Guaiacol 

Guaiacolis  carbonas 
Creosoti  carbonas 


^Creolin     (from     coal 
tar 


Cresol  (from  coal  tar) 
Liquor  oresolis, 
comp.  lysol 
Creta  prseparata;  see 

under  Calcium 
Croton  oil;  see  Oleum 

tiglii 
Cubeba  (Piper  e. ,  un- 
ripe fruit) 
Fluidextractum 

cubebae 
Oleoresina 
Oleum 
Trochisci 


N. 


N.  or 


N. 


53 
insol. 
insol. 


sol. 


sol. 
60 
sol. 


sol. 


50 


insol. 


sol. 


Protective  to  slight 
wounds  and  to  check 
superficial  hemor- 
rhages. 

Vesicant:  For  blister- 
ing purposes. 

Styptic. 


gr.  1-3      10.06-0.20     Tonic    cathartic:       In 

[  constipation;  in  full 

gr.  J-l      ,0.015-0.06       doses    powerful    hy- 

dragogue       cathartic; 

gr.  5-15     I      0.30-1  in     dropsies;     given 

usually  in  combina- 


1-3  pills 

1-5  pills 

gr.  5-30 

m5-30 
foi-l 
Tn5-15 


mi-8 

131-4 
ni2-15 
gr.  5-30 
m5-30 


mi-5 


mi-2 


f3i-l 

TT15-15 
m5-15 
gr.  i  of 
oleoresin 
in  each 


tion. 


0 .  30-2  ;  Heart  stimulant;  Diu- 
retic: Similar  to 
digitalis  in  action;  in 

0.30-2  large  doses  cathartic. 

l-i  Diuretic;  Expectorant: 

In    later    stages    of 

0.30-1  gonorrhea;      chronic 

I     cystitis  and  chronic 

bronchitis. 


0.03-0.20  Hemostatic:  In  hemor- 
rhage from  small 
vessels. 


1.06-0.50     Antiseptic:      In  aque- 
ous      solution       as 
■4-15  mouth- wash;     to 

0.12-1  check    fermentation 

0.30-2  within  the  digestive 

0.30-2  tract;    in    vomiting, 

flatulence  and  fer- 
mentative diarrhea; 
internally  in  phthisis 
and  other  pulmon- 
ary diseases:  guaia- 
col and  its  salts  have 
similar  uses. 
1.06-0.30  ^  Antiseptic:  Valuable 
for  general  use  as 
douche;  in  cystitis, 
intestinal  disorders. 
Antiseptic. 


0.03-0.12 
extern. 


1-2  Aromatic        stimula?it; 

diuretic:       Expector- 

1-2  ant:      In  bronchitis, 

pharyngitis  and 

0.30-1  laryngitis;       chronic 

0.30-1  inflammations         of 

genito-urinary  tract. 


t  X  grain  of  calomel  in  each. 


308 


INDEX  OF  DRUGS 


Page 

Drug. 

Reac- 
tion. 

Solubility  in 

Dose. 

Uses. 

in 

text. 

Water. 

Alcohol. 

Gm.  or  mil. 

80 

♦Cuprum,  copper 

104 

Cupri  sulphas 
Deadly  nightshade; 

see  Belladonna 
Dermatol;  see  under 
Bismuthum 

ac. 

2.5 

500 

gr.  i-5 

0.03-0.30 

In  full  dose  emetic; 
locally  astringent  and 
irritant;  to  stimulate 
indolent  ulcers;  as  a 
mild  caustic  applied 
to   granular   eyelids. 

Diacetylmorphina, 

al. 

1700   ;      31 

gr.  '/sr-'/io 

0.002-0.006 

Sedative:        In    cough 

heroin 

mixtures;  being  more 

Diacetylmorphinae 

N. 

2 

sol. 

gr.  V.o-Vio 

0.002-0.006 

powerful  than  mor- 

hydrochloridum 

phine,    it    must    be 

Diachylon  ointment; 

used  with  caution. 

see  under  Plumbum 

177 

Digitalis      (d.      pur- 

gr. i-2 

0.03-0.12 

Heart    stimulant    and 

224 

purea,  leaves) 

tonic;  Diuretic; 

250 

Fluidextractum 

mi-2 

0.03-0.12 

Strengthens          and 

Plate 

Infusum 

f3l-4 

4-15 

slows     heart    beats; 

xii 

Tinctura,  10% 

m5-20 

0.30-1.20 

in    weak   circulation 

Plate 

due  to  heart  dilata- 

iv 

tion  or  exhaustion. 

♦Digitalin 

gr.  '/eo-'/io 

0.001-0.002 

A  product  of  uncer- 
tain and  variable 
character. 

Diuretin;    see    under 

Theobroma 

Dobell's  solution;  see 

under  Sodii  boras 

Donovan's    solution; 

see   under     Arseni 

trioxid 

Dover's  powder;   see 

under  Opium 

Plate 

Elaterinum         (from 

N. 

insol. 

325 

gr.  ViO-Vio 

0.003-0.006 

Hydragogue    cathartic: 

xviii 

elaterium) 

In  dropsies,  cerebral 

293 

Trituratio  elaterini, 
10% 

gr.  i-1 

0.03-0.06 

hyperemia  threaten- 
ing apoplexy. 

Emetinse  hydrochlor- 

si. ac. 

V.  s. 

V.  s. 

gr.  J 

0.02 

Emetic:    May  be  used 

idum    (alkaloid    of 

hypodermically; 

ipecacuanha) 

recommended  in 

107 

Epinephrine;  the  ac- 

pyorrhea. 

tive     principle     of 

suprarenal  glands; 

see     Suprarenalum 

siccum 

Epsom  salt;  see  Mag- 

nesii  sulphas 

108 

Ergota,  ergot  of  rye 

Oxytocic;  Vasoconstric- 

Plate 
i 

Extractum    ergotse, 
"ergotin" 

gr.  2-8 

0.'l'2-<)'.5 

tor:  To  stimulate 
contraction  of  uterus 

Fluidextractum 

f3i-i 

1-4 

after  labor;  to  check 
capillary  hemor- 
rhages, menorrhagia, 

Eriodictyon,      yerba 

diarrheas;  to  reduce 

santa  (e.  californi- 

cerebral    and    spinal 

cum,  leaves) 

hyperemia. 

Fluidextractum 

mi5-30 

1-2 

Stimulant  expectorant: 

eriodictyi 

In   chronic   pulmon- 

Eserine;    see    under 

ary       diseases;       in 

Physostigma 

syrup  to  cover  bitter 

Ether,     chloric;     see 

taste  of  quinine. 

under    Chloroform 

Ether,     ethylic;     see 

^ther 

212  ,*Ethyl    bromide,    hy- 

spar. 

sol. 

inhaled 

Anesthetic:   Prompt  in 

drobromic  ether 

action,  but  danger- 

Ethyl   chloride;    see 

ous. 

yEthylis  chloridum 

! 

;*Ethyl  iodide,   hydri- 

insol.        sol. 



inhaled 

Anesthetic;    Alterative; 

j       odic  ether 

Stimulant. 

♦Ethylene   bichloride, 

inhaled 

Anesthetic:      Probably 

Dutch  liquid 

ranks  between  ether 

and    chloroform    in 
safety. 
Anesthetic:     Probably 

♦Ethylidene  chloride 

inhaled 

i 

less  depressing  than 

chloroform. 

INDEX  OF  DRUGS 


309 


Page 

Solubility  in 

Dose. 

Drug. 

Reac- 
tion. 

Uses. 

in 

text. 

Water. 

Alcohol. 

Gm.  or  mil. 

179 

Eucaine;     see    Beta- 
eucaine 

Eucalyptus  (e.  globu- 
lus, leaves) 

Formerly  in  malarial 
fevers;    oil    is    anti- 

Fluidextractum eu- 

iZi-2 

2-8 

septic,    used  ^  mostly 

calypti 

by      inhalation      in 

137 

Oleum 

N. 

insol. 

4 

m5-15 

0.30-1 

chronic    catarrhs    of 

140 

Eucalyptol  (from  ol. 
eucalypti) 

N. 

insol. 

sol. 

m2-io 

0.12-0.60 

respiratory  tract; 
eucalyptol  has  same 

137 

Eugenol  (a  constitu- 

si. ac. 

sol. 

mi-5 

0.06-0.30 

Similar  to  oil  of  cloves. 

139 

ent  of  oil  of  cloves) 

*Europhen,  28% 

insol. 

sol. 

extern. 

Antiseptic:   Substitute 

iodine 

for  iodoform. 

229 

Ferrum,  iron 

N. 

insol. 

inso 

Tonic:      Restorative  to 

Ferrum       reductum, 

N. 

insol. 

inso 

gr".  l-'5 

0.06-6! 30 

the  blood  in  anemia, 

reduced  iron 

chlorosis,       amenor- 

Liquor ferri  et  am- 

ac. 

fSl^ 

4-15 

rhea,  infectious  and 

monii  acetatis. 

wasting  diseases;  the 

Basham's  mixture 

preparations  may  be 
grouped   as   follows: 

Ferri    carbonas    sac- 

N. 

part. 

insol. 

1 

Oxides     and     carbon- 

charatus 
Massa  f .  carbonatis, 

[     gr.  2-10 

0.12-0.60 

ates;  their  prepara- 
tions    and    reduced 

Vallet's  mass 

J 

iron  are  restorative, 

Pilulse  f.  carbonatis, 

1-2  pills 

but  not  astringent. 

Blaud's  pill 

Ferri  chloridum,  fer- 

ac. 

V.  s. 

V.  s. 

gr.  1-5 

0.06-0.30 

The  mineral  acid  salts 

ric  chloride 

of  iron  are  astringent, 

102 

Liquor  f.  chloridi 

ac. 

m2-8 

0.12-0.50 

and     besides     being 

101 

Tinctura  f.  chloridi 

ac. 

m5-20 

0.30-1.20 

tonics,    are   used    as 

Ferri      et     ammonii 

N. 

sol. 

insol. 

hemostatics.        The 

citras 
Ferri      et      quininae 

ac. 

V.  s. 

part. 

gr.  2-10 

0.12-0.60 

sulphates  are  largely 
used  in  this  way;  the 

citras 

tincture  of  the  chlor- 
ide is  valuable  for 
internal  use,  com- 
bining tonic  prop- 
erties of  iron  and  hy- 
drochloric acid;  it 
has  long  been  used 
both  internally  and 
locally  in  erysipelas. 

PilulsB    ferri    iodidi 

1  to  2  pills 

The    compound    salts 

229 

Syrupus  f.  iodidi 

N. 

Ta5-30 

0.30-2 

possess  special  value 

88 

Ferri        hydroxidum 

insol. 

insol. 

31-4 

4-15 

according      to      the 

291 

cum  magnesii 

combination. 

note 

oxido;     ferric     hy- 
drate ;        hydrated 
oxide 

Ferri  phosphas 

si.  ac. 

sol. 

insol. 

}     gr.  1-5 

0.06-0.30 

*Ferri  pyrophosphas 

si.  ac. 

sol. 

insol. 

293 

Ferri  sulphas,  ferrous 

ac. 

1.4 

insol. 

The   iodide   is    altera- 

sulphate, copperas 

tive,      possessing      a 

Ferri  sulphas   exsic- 

ac. 

sol. 

insol. 

gr.  1-2 

0.03-0.12 

special      value      for 

catus 

scrofulous  children. 

Ferri  sulphas  granu- 

ac. 

sol. 

insol. 

The    hydrated    oxide 

latus 

is     the     best     anti- 

102 

*Subsulphate,    Mon- 
sel's  salt 

sol. 

gr.  1-3 

0.06-0.20 

dote  in  arsenical 
poisoning,  before  the 

102 

Liquor  ferri  subsul- 
phatis,      Monsel's 
solution 

ac. 

m2-io 

0.12-0.60 

poison  has  been  ab- 
sorbed; see  Table  of 
Poisons. 

102 

Liquor   f.    tersulph. 

ac. 

Used  chiefly  to  pre- 
pare other  salts. 

88 

*Dialyzed,     scales 

gr.  1-5 

0.06-0.30 

Recommended   as   an 

liquid 

mio-30 

0.60-2 

antidote  to   arsenic, 

Flaxseed;  see  Linum 

but  less  valuable 
than  hydrated  oxide. 

156 

♦Formaldehyde,  a  gas 

Disinfectant:         Most 

156 

Liquorformaldehydi, 
formalin,  37% 

n".  or 
si.  ac. 

extern. 

efficient  disinfectant 
for  rooms,   clothing, 

158 

Paraformaldehydum, 
paraform,  solid  for- 
maldehyde 

Fowler's  solution;  see 
under    Arseni    tri- 
oxidum 

Foxglove;    see    Digi- 
talis 

si.  sol. 

insol. 

gr.  2-10 

0.12-0.60 

books,  etc.;  in  solu- 
tion of  1%  or  less  as 
antiseptic;  to  soft  tis- 
sues in  very  dilute 
solution  on  account 
of  its  irritant  action; 
paraform  may  be 
used  internally;  to 
preserve  anatomical 
specimens. 

310 


INDEX  OF  DRUGS 


Page 

in 
text. 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Water.  Alcohol. 


Gm.  or  mil. 


Uses. 


Plate 
xviii 


97 


97 


137 
140 


111 
29 


Frangula     (rhamnus 

f.),  buckthorn 

(bark) 
Fluidextractum 

frangulae 
Friar's    balsam;    see 

under  Benzoin 
Galla,  nutgall  (from 

quercus  infectoria) 
Unguentiim 

Gambir,  catechu 
Tinctura  gambir 
composita 
Gamboge;  see  Cam- 


^Gaultheria,     winter- 
green  (leaves)  ' 
Oleum     gaultheriffi,    X.  or 
methyl  salicylate       si.  ac. 
*Spiritus 
Gelatinum 
Gelatiniim  glycerin- 
atum 


part. 


sol. 


sol. 


227     Gentiana    (g.    lutea, 
root) 
Extractum  gentianse 
Fluidextractum 
Tinctura  comp. 
Ginger;   see  Zingiber 
Glauber's     salt;     see 

Sodii  sulphas 
Glonoin;    see    Nitro- 
glycerin 
92     Glycerinum,  glycerol 
265 


29       Suppositoria  glj'cer- 
ini 

91      Glycyrrhiza    (g.    gla- 
bra), licorice  root 


Elixir  glycjTrhizae 
Extractum 
Extractum  punmi 
Fluidextractum 
Mistura  comp. 
brown  mixture 
Puh-is  compositus 

Glycyrrhizinum  am- 
moniatum 

Gold;  see  Aurum 

Golden  seal;  see  Hy- 
drastis 

Gossypium  purifica- 
tum,  cotton  (g. 
herbaceum,  hairs 
of  seed; 
Oleum  gossypii  sem- 
inis  (cotton-seed 
oil) 

Goulard's  extract ;  see 
Plumbum 

Gray  powder;  see  Hy- 
drargyrum 

Green  soap;  see  Sapo 
mollis 


sol. 


f3M 


gr.  10-30 
f34-2 


3i-2 

mi-10 

f3l-2 


gr.  2-10 
m5-30 
f3J-2 


ms-eo 


sol. 


f3l-4 

34-2 

gr.  2-10 


0.60-2 

2-8 


2-8 


Cathartic:  Fresh  bark 
is  harsh,  old  bark  is 
mild  and  efficient;  in 
chronic  constipation. 


Astringent:  Virtues 
due  to  the  tannic 
and  gallic  acids  con- 
tained. 

Astringent:  Owes  its 
value  to  tannic  acid. 


Aromatic;    Astringent: 
Substitute   for   sali- 
0.06-0.60        cylic    acid   in    rheu- 
matism;  used  as  fla- 
4—8  voring  agent. 

r .  .  .  .  To  prepare  capsules 
and  suppositories;  as 
coating  for  pills;  in 
hemophilia  by  rec- 
tum or  subcutane- 
ously. 

Bitter     tonic:     Simple 

stomachic  and  gen- 
0.12-0.60        eral   tonic;    contains 
0.30-2  no  tannin. 

2-8 


0.30-4 


freely 
freely 
freely 
freely 
4-15 

2-8 


Vehicle;  SoherU;  Pre- 
servative: Locally 
demulcent  and  emol- 
lient; in  enema  or 
suppository  for  con- 
stipation; sweeten- 
ing agent. 

Laxative:  For  intro- 
duction into  the  rec- 
tum. 

Expectorant:  Demul- 
cent: In  cough  mix- 
tures; to  cover  taste 
of  bitter  drugs. 

Vehicle. 


Contains 


Laxative: 

senna. 

0.12-1.20    Same  uses  as  licorice. 


To  prepare  surgical 
dressings;  as  absor- 
bent. 


Emollient:  substitute 
for  olive  oil;  applied 
to  burns,  etc. 


INDEX  OF  DRUGS 


311 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water.  Alcohol 


Dose. 


i  Gm.  or  mil. 


Uses. 


97 


158 


233 


150 
233 
293 

233 


232 


Guaiacum  (g.  officin- 
ale or  g.  sanctum) 
guaiac  (resin) 
Tinctura  guaiaci 
Tinctura  guaiaci 
ammoniata 

Guaiacol;  see  under 
Creosotum 

Guarana  (from  Paul- 
linia  cupana,  seeds) 
Fluidextractum 
guaranse 

Gum  Arabic;  see 
Acacia 

Guncotton;  see  Pyro- 
xylinum 

'Gutta-percha  (solu- 
ble in  chloroform, 
oil  of  turpentine, 
carbon  disulphide 
or  benzin) 
*Hamamelis,  witch- 
hazel  (h.  virginiana 
leaves  and  bark) 
Aqua  hamamelidis 

Fluidextractum 
*Hedeoma,  penny- 
royal  (leaves   and 
fl.  tops) 
Oleum  hedeomae 
*Heroin;  see  Diacetyl- 
morphine 
Hexamethylenamina, 

urotropin 
Hoffman's    anodyne; 
see  under  ^ther 

*Holocaine  hydrochlo- 
ride 

Homatropine;  see 
under  Atropine 

Honey;  see  Mel. 

Hydrargyrum,  mer- 
cury, a  metal 

Hydrargyrum      cum 
creta,  gray  powder, 
38% 
Massa     hydrargyri, 

blue  pill,  33% 
Oleatum  (25%  yel- 
low oxide) 
Unguent um,  blue 
ointment,  50% 
Unguentum  hyd. 
dilutum,  30%, 

Hydrargyrum  ammo- 
niatimi,  white  pre- 
cipitate 
Unguentum  hy- 
drargyri ammo- 
niati,  10% 

Hydrargyri  chlori- 
dum  corrosiviim, 
mercuric  chloride, 
corrosive  sublimate 

Hydrargyri  chlori- 
dum  mite,  mercur- 
ous  chloride,  calo- 
mel 
♦Hydrargyri  cyani- 
dum 

Hydrargyri  iodidum 
flavum 

Hydrargyri   iodidum  j 

rubrum 

Liquor      arseni     et 

hydrargyri    iodidi, 

Donovan's  solution 


insol. 


N. 


40t 


insol. 


aim. 
insol. 


13.5 


insol. 


12.8 

aim. 
insol. 
aim. 
insol. 


insol. 


12.5 


insol. 


aim. 
insol. 

3.8 
insol. 

15 

insol. 
115 


gr.  5-30  0.30-2 


m-2 

f3i-l 


3i-l 


31-2 


f3l-2 


mi-5 


gr.  5-15 


gr.  2-10 
gr.  2-10 


2-8 
1-4 


1-4 
1-4 


2-8 


2-8 


0.0&-0.30 


0.30-1 


extern. 


0.12-0.60 
0.12-0.60 


Alterative:  In  rheuma- 
tism, gout,  tonsil- 
litis, myalgia,  sciatica 
and  syphilis. 


Tonic;     Stimulant: 
Similar  in  action  to 
coffee;    used   in   mi- 
graine. 


Protective:  In  making 
splints  and  surgical 
appliances;  as  tem- 
porary filling  for 
teeth. 

Feeble  astringent:  In 
hemorrhages,  hemor- 
rhoids; locally  to 
bruises  and  inflam- 
mations. 

Aromatic;  Carmina- 
tive: In  colic;  used 
also    externally. 


Antiseptic:  When 

given  internally  lib- 
erates formaldehyde 
during  elimination 
by  the  kidneys. 

Local  analgesic:  Same 
uses  as  cocaine,  but 
probably  more  toxic. 

Metallic  meicury  used 
in  gray  powder,  blue 
pill,  and  ointment, 
in  a  very  finely  di- 
vided state;  prepa- 
rations of  mercury 
are  alterative  and 
purgative;  it  is  the 
chief  remedy  in  sec- 
ondary syphilis ;  blue 
pill  is  cathartic,  but 
should  be  followed 
by  a  saline;  ointment 
and  oleate  by  inunc- 
tion to  obtain  sys- 
temic effect. 


gr.  i/eo-Vio   0.001-0.006  The    most    poisonous 
I     salts     are     corrosive 
I     chloride,  cyanide  and 
I     red  iodide.    Corrosive 
gr.  4-10       0 .  03-0 .  60       sublimate  is  efficient 
for  internal  use;   in 
secondary    and    ter- 
tiary syphilis,  is  fre- 
gr.  V6(r-Vio    0.001-0.0061     quently       combined 
:  with  iodides;  it  is  a 

gr.  6-j         0.01-0.03        powerful      antiseptic 
I  in  1:2000  or  weaker 

:r.  i/eo-Vio  |0. 001-0. 006     solution  as  douche  or 
irrigation. 
mi-8  0.06-0.50 


t  Soluble  in  boiling  water,  which  upon  cooling  leaves  a  2.5  per  cent,  solution. 


312 


INDEX  OF  DRUGS 


Page 

1 

Solubility  in                       Dose. 

Drug. 

tion. 

Uses. 

in 

text. 

Water. 

Alcohol.                          Gm.  or  mil. 

Unguentum  hy- 

Calomel  is  a  mild  and 

drargyri     nitratis, 

certain   cathartic   as 

citrine  ointment 

occasional   purge   in 

Hydrargyri     oxidum 

aim. 

insol. 

fevers    and    inflam- 

flavum 

insol. 

matory  diseases;  an 

Unguentum  hy- 

extern. 

efficient    diuretic    in 

drargyri  oxidi  flavi 

dropsies;     in      diar- 

10% 

rheas  in  small  doses; 

Hydrargyri     oxidum  1 

aim. 

insol. 

1     locally  as  a  sedative, 

rubrum,    red    pre- 

insol. 

I 

alterative       applica- 

cipitate 

tion  to  ulcers. 

Hydrargyri   salicylas 

aim. 
insol. 

aim. 
insol. 

gr.  i-1  . 

0.008-0.06  i  The  salicylate  may  be 
i     usedhypodermically. 

♦Black  wash  (1  gm. 

extern. 

Black  wash  and  yellow 

calomel,   115.5  c.c. 

wash  are  applied  to 

lime-water) 

syphilitic  ulcers. 

♦Yellow  wash  (1  gm. 

extern. 

corrosive         subli- 

mate, 308  c.c.  lime- 

water) 

Hydrastis,  golden 

gr.  5-60 

0.30-^ 

Bitter  tonic:    in  atonic 

seal  (h.  canadensis, 

indigestion;     altera- 

root) 

tive  to  mucous  mem- 

Extractum hydrastis 

gr.  2-15 

0.12-1 

branes;    in    diseases 

Fluidextractum 

m5-60 

0.30-4 

of  genito-urinary  or- 

Glyceritum, 100% 

m5-60 

0.30-4 

gans. 

Tinctura 

iZh-2 

2-8 

Hydrastina 

ai. 

si.  sol. 

170 

gr.  i-i 

0.015-0.03 

Hydrastininse  hydro- 

ac. 

V.  s. 

V.  s. 

gr.  1-1 

0.03-0.06 

Hemostatic:  In  uterine 

chloridum 

hemorrhages,  dys- 
menorrhea. 

115 

Hydrogen       dioxide, 

si.  ao. 

local  use 

Disinfectant:  To  clean 

153 

official     as     liquor 
hydrogenii   dioxidi 
(3%),   peroxide  of 
hydrogen,     10-vol- 
ume    solution,    in 
water 

ulcers  and  wounds; 
to  clean  pulp  cham- 
bers and  canals. 

80 

Ethereal  solution  of 

local  use 

Caustic:        to    bleach 

161 

hyd.  dioxide,  25% 
Hydronaphtol ;       see 
Betanaphtol 

teeth. 

223 

Hyoscinse   hydrobro- 

293 

midum;  see  Scopo- 
lamine 

293 

Hyoscyamus,       hen- 
bane (h.  niger,  Ivs. 
and  fl.  tops) 

gr.  2-10 

0.12-0.60 

In  action  it  is  similar 
to  belladonna,  but 
more     sedative     and 

Extractum    hyos- 

gr.  i-2 

0.03-0.12 

hypnotic;   in   insom- 

cyami 

nia,  mania,  delirium 

Fluidextractum 

m2-io 

0.12-0.60 

tremens;     it     quiets 

Tinctura 

f3i-i 

1-4 

peripheral  irritation, 

223 

Hyoscyaminse  hydro- 
bromidum 

Hypophosphites 

N. 

V.  8. 

2!5 

gr.  i/joo 

0.0003 

nervous  cough,  irri- 
tability of  bladder. 

Hyoscyamine  is  ano- 
dyne and  mydriatic. 

Tonic;          Restorative: 

231 

Syrupus   hypophos- 
phitum 

£31^ 

4-15 

In  wasting  diseases, 
tuberculosis,  rachitis. 

♦Syrupus  hypophos. 

f31-2 

4-8 

nervous  diseases. 

compositus 

254 

Hypophysis       sicca, 
dried  pituitary 
body 

gr.  i-1 

0.015-0.06 

Oxytocic:  Causes  stim- 
ulation of  vascular 
system,      with      in- 

Liquor hypophysis 

mi5 

1 

creased     blood-pres- 

♦Pituitrin 

m8-30 

0.5-2 

Bure. 

♦Ichthyol 

b1.  ac. 

sol. 

part. 

extern. 

Antiseptic;    Alterative: 

♦Lotion  or  ointment 

extern. 

Applied  to  skin  dis- 

Indian     hemp;      see 

eases, inflammations. 

Cannabis  indica 

Iodine;  see  lodum 

143 

lodoformum,      iodo- 
form. 96.7%  iodine 
Unguentum       iodo- 
formi,  10% 

N. 

aim. 
insol. 

60 

gr.  1-5 

0.06-0.30 
extern. 

Used  externally;  alter- 
ative; antiseptic:  as 
powder  to  wounds 
and  ulcers. 

143 

♦lodolum,  iodol,  89% 
iodine 

insol. 

9 

gr.  1-3 

0.03-0.20 

Antiseptic:  Same  uses 
as  iodoform. 

INDEX  OF  DRUGS 


313 


Page 


Drug. 


Reao- 
i  tion. 


Solubility  in 


Dose. 


Uses. 


Water.  Alcohol. 


63     lodiim,  iodine 

65       Liquor  iodi  compo- 

143         situs,  Lugol's  solu- 

233         tion,     5%     iodine, 

293  ;       10%  iodide  of  po-  ^ 

tassium  I 

i     Tinctura  iodi,  7%     I 

Unguentum,  4% 

91  I  Ipecacuanha,    ipecac 

251  I       Ccephaelis  i.  root) 

252  ■  ,        I 
Fluidextractum  ipe- 

j       cacuanhse  ' 

'     Syrupus,  7% 

Pul\as  i.  et  opii;  see 

under  Opium 
Tinctura  i.  et  opii; 
see   under   Opium; 
see  Emetine 


284  ;*Iris  florentina,   orris 
i       root 
Iron;  see  Ferrum 
Itrol;      see      Argenti 

citras 
Jaborandi;    see   Pilo- 
carpus 

Plate  I  Jalapa    (exogonium 
xviii  j       purga,  root) 
Puhas  comp. 
Resina 

*Juniperus       commu- 
nis (ripe  friut) 
251        Oleum  juniperi 
j     Spiritus 

Spiritus  comp. 
*Infusion 
97  :  Kino       (pterocarpus 
marsupium,  inspis- 
sated juicej 
Tinctura  kino 
97    *Krameria,      rhatany 
(k.  triandra  and  k. 
ixina,  root) 
*Extractum        kra- 


*Fluidextractum 
*Tinctura 
*Trochisci 
Labarraque's 
tion;      see 
Chlorine 
Lactuoarium,  lettuce 
(lactuca        \'irosa, 
concrete  juice) 
Syrupus     lactucarii 
Tinctura 
Lanolin;    see    Adeps 

lanse  hydrosus 
Lard;  see  Adeps 
Laudanum ;    see    un- 
der Opium 
Laughing     gas;     see 
Nitrogenii  monoxi- 
dum 
''Lavandula  officinalis, 
lavender  (flowers) 
Oleum       lavandulae 
Spiritus 
Tinctura  comp. 
Lead;    .see   Plumbum 
Lemon  peel;  see  Lim- 

onis  cortex 
Licorice      root ;      see 

Glycyrrhiza 
Lily    of    the    valley; 

see  Convallaria 
Lime;  see  Calx 


2950        12 . 5 


si.  ac. 


insol.  I     sol. 


insol. 


si.  sol. 


solu- 
under 


sol. 


mi-o 


ITll-3 
gr.'  i-30 


mi-5 

mi5-30 

TTl5-f32 


gr.  5-30 


gr.  5-20 

3J-2 
gr.  1-10 

3i-i 

m2-io 
f3i-i 

f3i-i 

f5i-2 

gr.  5-15 


f3i-2 
gr.  5-15 


gr.  5-10 

m5-30 
f3f-2 

1-5 
troches 


gr.  5-30 


f31-4 
f3i-i 


Gm.  or  mil. 


0.06-0.30 


0.06-0.20 
extern. 
0.06-2 


0.06-0.30 
1-2 

0.30-8 


0.30-2 


0.30-1.30 

2—8 
0.06-0.60 

1-4 

0.12-0.60 

1-4 

4-15 

15-60 

0.30-1 


1-8 
0.30-1 


Alterative;  Antiseptic: 
In  tertiary  sj-philis, 
scrofula,  glandular 
enlargements;  inter- 
nally mostly  in  the 
form  of  iodides;  the 
tincture  is  much 
used  as  a  counter- 
irritant;  to  disinfect 
wounds,  to  prepare 
site  of  operation. 

Expectorant. 

Emetic  in  large  doses; 
one  of  the  safest 
emetics;  in  cough 
mixtvires,  and  in 
treatment  of  pyor- 
rhea; sjTup  to  chil- 
dren in  croup  and 
bronchitis,  to  rid  air 
passages  of  mucus ;  in 
diarrheas  combined 
with  other  remedies; 
diaphoretic  when 
combined  with 
opivim. 

Used  chiefly  in  tooth 
powders;  tincture  in 
perfumery  and  as 
flavoring. 


Hydragogue  cathartic: 
In  dropsies;  as  de- 
pleting agent  in  cere- 
bral hyperemia  or 
serous  effusions. 

Stimulant  diuretic: 
Usually  combined 
with  other  diuretics; 
in  dropsies,  chronic 
catarrhs  of  urinary 
tra'ct. 

Astringent:  In  diar- 
rheas; as  gargle. 


Astringent:      In   diar- 
rheas, hemorrhages; 
locally     to     relaxed 
0.30-0.60  I     mucous  membranes, 
spongy     gums;     as 
0.30-2  injection    in    fissure 

2-8  of    anus    or    hemor- 

rhoids. 


0.30-2 


4-15 
1-4 


j  Mild  sedatire  and  hyp- 
[  notic,  somewhat  like 
I  opium,  but  much 
feebler;  used  chiefly 
I     as  vehicle. 


mi-5 

0.06-0.30     Flavoring   agent: 

f3l-l 

2-4             carminative. 

f3i-l 

2-4 

As 


314 


INDEX   OF  DRUGS 


Page 

in 
text. 


Drug. 


H  Pac- 
tion. 


Solubility  in 


Water.  Alcohol.' 


Gm.  or  mil. 


Uses. 


Limonis  cortex, 
lemon  peel 
Oleum  limonis 
*Spiritus 

*Limonis  succus, 
lemon-juice 
Syrupus  acidi  citrici 


Linseed  oil;  see  under 
Linum 
91      Linum     (1.     usitatis- 

simum),  flaxseed 
90       Oleum  lini,  linseed 
I       oil 

*Infusion 
*Lithium,  a  metal 
Lithii  bromidum 
Lithii  carbonas 
Lithii  citras 


♦Litmus,  lacmus 
*Tincture 

Lobelia  (1.  inflata), 
Indian  tobacco 
(leaves   and    tops) 

Fluidextractum  lo- 
belise 

Tinctura 


143    *Losophane,  cresol  tri- 
■iodide,  78%  iodine 
Lugol's  solution;  see 

under  lodum 
Lunar     caustic ;     see 

under  Argentum 
Lycopodium    (1.    cla- 
vatum    and    other 
species)    (sporules) 
*Lysol;  see  under  Cre- 
sol 
*Magnesiftm,  a  metal 
120  I     JVIagma  magnesiae, 
291   I       milk  of  magnesia 
Magnesii  carbonas 

120  !     Magnesii  oxidum 
•     Magnesii       oxidum 
ponderosum, 
heavy  mag.  oxide 
Plate       Magnesii  sulphas, 
Epsom  salt 
Male  tern;  see  Aspi- 
dium 


Maltum,  barley  malt 
Extractum  nialti 
Mandrake;  see  Podo- 
phyllum 
*Mariganum,    manga- 
nese 
Mangani   dioxidum 

prsecipitatum 
Potassii    perman- 
.    ganas 

Manna    (from    frax- 
inus  ornus) 
♦Mastiche,      a     resin 
from   pistacia  len- 
tiscus 

May  apple;  see  Podo- 
phyllum 


si.  al. 
al. 

N. 


Ta2-10 
freely 


f31-4 


iih-2 


0.6 
78 
1.4 


misc. 

aim. 
insol. 
spar, 
spar. 


V.  s. 
insol. 

aim. 
insol. 


insol. 
13.5 


insol. 


insol. 
insol. 


aim. 
insol. 


gr.  5-20 
gr.  2-10 


gr.  1-5 

mi-5 

nV5-30 


f31-4 
3i-2 


0.12-0.60 


freely 
4-15 


15-60 

freely 


Preparations  of  lemon 
peel  used  chiefly  as 
flavoring  agents;  the 
syrup  of  citric  acid 
as  vehicle. 

Antiscorbutic:  In 
scur\'y,  acute  rheu- 
matism; refrigerant 
drink  in  fevers;  to 
lessen  acidity  of 
urine;   as   vehicle. 

In  poultices;  infusion 
as  demulcent  drink; 
oil  is  demulcent;  ap- 
plied freely  to  burns. 


0.30-1.30  \  Antacid;    Diuretic: 

Salts  used  to  produce 

0.12-0.60  I  alkalinity  of  urine 
in  uric  acid  diathe- 
sis, gout. 

Coloring    agent:        To 

prepare    test    paper 
for  acids  and  alkalies. 

0.06-0.30     Emetic;      Expectorant: 

'     Too    harsh    as    an 

emetic;  used  as  anti- 

0.06-0.30       spasmodioinasthma; 
in     bronchitis;     has 
0.30-2  been  used  in  poison- 

ing by  poison  ivy. 
Antiseptic:  Locally  in 
solution  or  ointment 
in  parasitic  skin  dis- 
eases, but  not  when 
acute  inflammation 
is  present. 
Applied  to  excoriated 
surfaces  as  protective 
and  absorbent;  in  pre- 
paring pills. 


4-15 


gr.  5-60  !      0.30-4 


insol. 

t 


5i-l 


f31-4 

gr.  2-10 
gr.  ^-2 

5i-l 


8-30 


4-15 


Antacid;  Laxative;  also 
as  antidote. 

Antacid;  Laxative:  In 
acidity   of   stomach. 

To  prepare  antidote 
to  arsenic;  light  and 
heavy  oxides  and 
carbonate  are  mild 
laxatives;  the  sul- 
phate is  active  ca- 
thartic; as  cathar- 
tic in  fevers,  inflam- 
mations, obstruction 
to  portal  circulation, 
dropsies. 

Food  tonic;  Digestant: 
In  wasting  diseases; 
to  aid  digestion  of 
starch. 


(7. 12-0.60  j  Tonic  in  small  doses; 
0.03-0.12 


8-30 


insol.       part. 


emmenagogue. 

Antiseptic:  Used  loc- 
ally in  diphtheria, 
scarlatina,  etc. 

Demulcent;      Laxative, 

In  dentistry  to  fill 
cavities  of  carious 
teeth  temporarily. 


t  Decomposition  occurB. 


INDEX  OF  J  DRUGS 


315 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water.  Alcohol 


Dose. 


Gm.  or  mil. 


Uses. 


141 


141 


137 
140 


246 

294 

Plate 

xvii 


132 


296 

179 


Mel,  honey 
Mel  depuratum, 
Mentha  piperita, 
peppermint  (leaves 
and  tops) 
Aqua  mehthse  pip- 
eritse 
Oleum 
Spiritus 

Menthol  (from  oil  of 
peppermint) 


Mentha  viridis, 
spearmint    (leaves 
and  tops) 
Aqua  menthse  v. 
Oleum 

Spiritus 
Menthol;    see    under 

Mentha  piperita 
Mercury;  see  Hy- 
drargyrum 
Methyl  salicylas,  oil 
of  wintergreen 
♦Methylene  bichloride 

♦Methylene  chloride 
Monsel's     salt;      see 

under  Ferrum 
Morphina  (from 

opium) 

♦Morphinae  acetas 

Morphinge      hydro- 

chloridum 
Morphinae     sulphas 

*Pulvis     morphinse 
compositus;     Tul- 
ly's  powder 
Mustard;  see  Sinapis 
Myristica     (m.     fra- 
grans),  nutmeg 
Oleum  myxisticse 


Myxrha,  a  gum  resin 
from    commiphora 
myrrha 
Tinctura  myrrhse 

Naphtol;    see    Beta- 

naphtol 
♦Nicotine  (from 

tobacco) 
*Nirvanin 


si.  ac. 


N. 


N. 


N.  or 
si.  ac. 


N.  or 
si.  ac. 


sol. 


si.  sol. 


sol. 


sol. 


224 

294 

Plate 


199 


N.  or 
si.  al. 
N.  or 
si.  ac. 
N.  or 
si.  ac. 


N. 


176    *Nitroglycerin,       glo- 


Spiritus  glycerylis 
nitratis,  1%  solu- 
tion of  nitrogly- 
cerin in  alcohol 

Nitrogenii     monoxi- 
dum,  nitrous  oxide 
(laughing  gas) 
Nutgall;  see  Galla 
Nutmeg;   see   Myris- 
tica 


3340 


2.25 
17.5 


15.5 


insol. 


part. 


N. 


sol. 


sol. 


210 


216 


565 


part. 


V.  s. 
V.  s. 


fSi-2 

mi-5 
m5-i5 

gr.  1-3 


f§i-2 

mi-5 
m5-i5 


mi-10 


gr.  5-15 
gr.  5-15 

mi-5 


freely         Vehicle;  Demulcent. 

Aromatic  stimulant: 
The  water  as  vehicle; 
all  preparations  as 
carminative;  in  flat- 
ulence, colic;  the  oil 
locally  is  anodyne; 
diluted  to  relieve 
pruritus. 

Menthol  locally  as 
anodyne  in  head- 
aches; internally  as 
antiseptic. 

Similar  to  pepper- 
mint, but  weaker. 

15-60        As  vehicle. 
0.06-0.30 

0.30-1 


15-60 


0.06-0.30 
0.30-1 


0.03-0.20 


0.06-0.60 


f3i-l 

gr.  i-5 

gr.  Vzoo-'/M 

mi-3 


Same  uses  as  oil  of 
gaultheria. 

Anesthetic:  Not  so  safe 
as  ether. 

Anesthetic:  used  most- 
ly locally. 


Anodyne:  In  large 
doses  narcotic;  uses 
same  as  those  of 
opium,  but  it  is 
0 .  007.5-0 .  15  less  constipating  and 
acts  more  quickly; 
preferred  for  hypo- 
dermic use;  poison- 
ing and  habitual  use 
0 .  30-1  must     be     guarded 

against. 


0 .  30-1  Aromatic;  Stimulant: 
In  large  doses  nar- 
0.06-0.30  cotic;  used  as  a  con- 
diment; as  carmina- 
tive; the  volatile  oil 
is  rubefacient. 
Tincture  locally  as 
antiseptic  and  stimu- 
lant to  mucous  mem- 
branes; applied  to 
spongy  gums. 


0.002-0.006  Sedative:  'PoiBonous. 

0.03-0.30  Local  analgesic:  Same 
uses  as  cocaine,  being 
less  toxic. 

0.0003-. 001  Arterial  stimulant:  In 
]  cardiac  diseases,  ar- 
I  teriosclerosis;  ner- 
0.06-0.20  i  vous  disorders  de- 
pending upon  arte- 
rial tension;  angina 
pectoris;  headache 
and  neuralgia, 
inhaled  i  Anesthetic:  Has  very 
transient  effect, 

therefore  suitable  for 
slight  operations,but 
with  oxygen,  its  in- 
halation may  be  con- 
tinued for  extensive 
operations. 


316 


INDEX  OF  DRUGS 


Page 


Drug. 


Reac- 
tion. 


Solubility  in 


Water.  Alcohol. 


Dose. 


Gm.  or  mil. 


Uses. 


223 

228  I 
Plate 
xi     I 
294 


137 
140 
231 


Plate 


Plate 
xviii 
66 
246 
Plate 
xvii 
114 
294 


262 


247 
294 


Mux  vomica  (strych- ,      .  .      i      ... 

nos  n.  v.,  seeds)       ' 
Extractum  nucis  i      .  .      i     ... 

vomicEe 

Fluidextractum  |      . .  ... 

Tinctura  I      . .  ... 

See  Strychnina  I 

♦Oleum  betulae,  oil  of       N.        insol 

sweet  birch 
Oleum  cadinum  (from     ac. 

juniperus    oxyced- 

rus)  oil  of  cade 
Oleum    cajuputi,    oil      N. 

of  cajuput 
Oleum  morrhuse,  cod-    si.  ac 

liver  oil  . 

Emulsum  olei  mor-  j 

Oleum  olivse,  olive  oil 
Oleum   ricini,   castor 

oil 
Oleum  santali,  oil  of   si.  ac 

sandal-wood 
Oleum   tiglii,   croton      ac. 

oil 


aim. 
insol. 


insol. 
insol. 


insol. 
insol. 


insol. 


sol. 
part. 


sol. 


si.  sol. 

1 


sol. 


insol.     si.  sol. 

I 


255 


Opium ;  concrete  juice 

of  unripe  capsules 

of     opium     poppy 

(papaver  somnifer- 

um),        containing 

not  less  than  9.5% 

morphine 

Opium   deodoratum 

Opium    granulatum 

Opii     pulvis,     each 

contains  10-10.5% 

morphine 

Extractum  opii 
*Pilul8e  opii 


The  following  contain 
each  10%  opium: 
*Acetum  opii,  black 
drop 
Tinctura  opii,  laud- 
anum 
Tinctura    opii   deo- 
dorati 
*Tinctura    ipecacu- 

anhse  et  opii 
*Vinum  opii 
Pulvis  ipecacuanhse 
et     opii,     Dover's 
powder,  10% 
opium 
Tinctura  opii  cam- 
phorata,  paregoric, 
0.4%  opium 
See     Codeina     and 
Morphinse 
Orange     peel;        see 

Aurantii  cortex 
Orris   root;    see    Iris 
florentina 
♦Orthoform  N. 

Otto     of     rose;     see 

under  Rosa 
Oxygenium,  oxygen 


Pancreatinum,    pan- 
creatin 


si.  sol. 


sol. 


sol. 


insol. 


gr.  J-2 
gr.  i-i 


mi-2 

Tn5-20 


lUl-5 


mi-10 

f3i-i 
f32-8 


f5i-2 
Tn2-10 
nij-2 


gr.  i-1 

gr.  1  in 

each 


m3-i5 


gr.  3-15 

m3-20 
child 
f31-4 
adult 


gr.  1-15 


i  0.03-0.12     Bitter  tonic;  Stimulant 
I  to   nervous    system; 

|0 .  0075-0 .  03     in  atonic  indigestion, 
gastric    catarrh;    in 
paralysis,       inconti- 
0.03-0.12        nence  of  urine,  neu- 
0.30-1.30       ralgia    and    respira- 
tory     and      cardiac 
weakness. 
0.06-0  30     Same    uses    as    oleum 
gaultheriffi. 

Externally:  In  scabies, 

psoriasis. 

0.06-0.60  Stimulant:  Antiseptic: 
As    carminative. 

4-15  Tonic:  Alterative:     As 

a  fatty  food  in  wast- 

8-30  ing  diseases. 


freely 
8-^0 


Laiatire; 
Cathartic. 


Emollient 


0.12-0.60     Alterative:  Gonorrhea, 
chronic    bronchitis. 
0.015-0.12    Drastic  cathartic:  Used 
as   revulsive;   extern- 
ally it  is  vesicant. 
gr.  J-2        0.015-0.12    Anodyne  and  narcotic: 
danger  of  poisoning 
and      habitual      use 
must      be      guarded 
against;     it     lessens 
secretions         except 
perspiration;      mod- 
erate doses,   accord- 
I  ing   to   some,  stimu- 

gr.  J-l J  !  0 .  015-0 .  10  late  the  heart ;  af ter- 
1  effects  of  a  full  dose 
I  are  headache,  nausea 
I  and  constipation. 

0.0075-0.06  Used  to  relieve  pain 
and  spasm;  in  diar- 
rhea and  dysentery 
to  lessen  peristalsis; 
in  pneumonia,  bron- 
chitis, and  pleuritis 
to  allay  pain  and 
cough.  In  peritonitis 
0.20-1  typhoid  fever,  t>T3h- 

litis,   etc.,   to  lessen 
pain  and  peristalsis; 
in      heart      diseases 
i     with  angina  pectoris 
i     or   cerebral   anemia; 
0.20-1      j     Dover's    powder    is 
'     diaphoretic,  very  use- 
0.20-1.20  j     ful  in  pulmonary  dis- 
eases, myalgia,  lum- 
4-15        I     bago,  etc. ;  for  hypo- 
i     dermic  use  morphine 
is   preferred. 


gr.  5-15 


0.06-1 


inhaled 


0.30-1 


Analgesic:  Applied 
locally  to  painful 
ulcers  or  wounds. 

Restorative:  In  pul- 
monary diseases,  ap- 
nea, croup,  diph- 
theria; also  used 
with     anesthetics. 

Digestant:  Aids  diges- 
tion of  starches,  fats 
and  proteids;  also 
used  to  peptonize 
milk  and  other  foods 
before  feeding. 


INDEX  OF  DRUGS 


3i: 


Page 

in     j 
text.  ' 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Water.  AlcohoL 


Gm.  or  mil. 


Uses. 


255 


28 


90 


75 
127 
291 


128 


Plate 
xviii 
135 


230 
295 


ParafEnum  (from  pe- , 
troleum)  I 

Paraf orm ;  see  under 
Formaldehyde 

Paraldehydum 

Paregoric;  see  under 

Opium 
Pearson's      solution; 
see     under     Arseni 

triosid 
Pennyroyal;  see 

Hedeoma 
Pepo,  pumpkin  seed 
Pepper.  Cayenne;  see 

Capsicum 
Peppermint;  see 

^lentha  piperita 
Pepsinum,  pepsin 
Peroxide    of    hydro- 
gen;  see  hydrogen 

dioxide 
Petrolatum,  vaseline 
Petrolatum      album, 

albolene 
Petrolatum  liquidum 


insol.      insol. 


X.  or 

si.  ac. 


si.  ac. 


50 


f3i-i 


51-3 


aim.         gr.  1-15 
insol. 


♦Petroleum,  coal  oil 
Phenacetin;  see  Acet- 

phenetidinum 
Phenol,  carbolic  acid 

Phenol  liquefactiun, 

87% 
Glvceritum    pheno- 

lis,  20% 
Unguentum 
*Liquor  sodii  carbo- 

latis,  phenol  so- 

dique 
Phenolphth  aleinum , 

phenolphthalein 
Phenylis       salicylas, 

salol 


Phosphorus 
Pilula       phosphori 
See    Acidum    phos- 

phoricum 
See  HjT)ophosphites 


Physostigma  (p.  ven- 
enosum),     calabar 
bean 
Extractum    physos- 

tigmatis 
Tinctura 

*Eserine    (same    as 
physostiginine) 
Physostigminae  sali- 
cylas 
Pilocarpus    (p.   jabo- 
randi.  leaflets) 
Fluidextractum  pil- 
ocarpi 
PilocarpinsB      hydro- 

chloridum 
Pilocarpinas  nitras 
Pilulse    catharticEB 
comp ;    see    under 
ColocjTithis 


si.  ac. 


15 


N. 


aim. 
insol. 
6670 


insol. 


400t 


f5i-l 


X.  or 

si.  ac. 


local  use 


gr.  1-5 
gr.  1-5 


gr.  Vijo 
gr.  i/ioo 
in  each 


gr.  i-2 

gr.  Vio-i 

mio-30 

gr.  '/loo-^'ii 
gr.  5-60 
m5-60 


30-90 


Protective:  To  protect 
surfaces  from  moist- 
ure  or   air. 

Hypnotic:      Less    cer- 
tain    than     chloral, 
i     but  safer. 


Anthelmintic:  Given 
in  emulsion  to  re- 
move  tapeworm. 


0  06-1        Digestard:        In    indi- 
gestion due  to  lack 
I .   of  gastric  juice. 

'  Basis  for  ointments. 


8-30         LaxatiieinterraaMy;  de- 
mulcent   locally;    as 

I    vehicle. 

I  Source     of    rhigolene 

benzin,    petrolatum, 
paraffin,  etc. 
0.03-0.12     Corrosize;     Antiseptic; 

I     Local  sedatixe  in  di- 

I  lute  solution;  as 
mouth-wash,    gargle 

'  or  internal  antisep- 
tic; in  vomiting, 
diarrhea,  and  indi- 
gestion due  to  fer- 
mentation. 

0.06-0.30  Cathartic:  Safe  and 
efficient;  reagent. 

0.06-0.30  Intestinal  antiseptic; 
in  diarrhea,  fermen- 
tative indigestion, 
rheumatism. 
0.0005  Resioratire  tonic:  In 
depressed  condition 
of  neri-ous  system, 
neuralgia ;  largely 
employed  in  form 
of  phosphoric  acid, 
phosphates,  and  hy- 
pophosphites  as  gen- 
eral restorative  in 
wasting  diseases. 

0.03-0.12  Sedative;  Myotic:  To 
depress  excitability 
of    spinal    cord;    in 

0.006-0.03       tetanus,     strj-chnine 

poisoning,     progres- 

0.60-2  sive  paralysis  of  the 

insane;    to    contract 

pupU. 

0.0006-.002  To  contract  pupil. 


0.30-4 
0.30-4 


0.3 


gr.  Vif-i      0.005-0.02 
gr.  >/ii-i      0.005-0.02 


Powerful  diaphoretic; 
sialagogue;  in  acute 
catarrh,  acute  in- 
flammations of  ser- 
ous membranes;  in 
acute  sthenic  fevers 
and  dropsies  when 
heart  is  not  weak; 
pilocarpine  may  be 
used  h>-podennically . 


t  Absolute  alcohoL 


318 


INDEX  OF  DRUGS 


Page 

in 
text. 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Water.  .-Vlcohol. 


Gm.  or  mil. 


Uses. 


*Pilul£e    catharticae 
veg.;      see     under 
Colocynthis 
Piperina   (from   pep-      X. 

per,  piper  nigruin) 
*Piperazine,   piperazi- 

dine 
Pituitrin;    see    under 

HjTJophysis 
Pix  liquida,  wood  tar      ac. 
(from  pine) 
Oleum  picis  liquidse 
Syrupus 

Unguentum,  50%      [      . . 
Plaster  of  Paris;  see 

Calcii  sulphas 
*Platinum,  a  metal 
*Platinic  chloride 
♦Plumbum,  lead 

104  Plumbi  acetas,  sugar    si.  al. 
293         of  lead 

Liquor  plumbi  sub-       al. 
acetatis,  Goulard's 
extract 

105  Liquor  plumbi  sub-       al. 

acetatis       dilutus, 
lead-water 
♦Plumbi  nitras  ac. 

Plumbi  oxidum,  lith-      al. 
arge 

Emplastrum  plum- 
bi, lead  plaster; 
diachylon  plaster 

Unguentum  diachy- 
lon 


Plate    Podophyllum,    man- 
xviii         drake     (p.     pelta- 
i       turn,  root) 

♦Extractum     podo- 
phylli 
Fluidextractum 
Resina,  "podophyl- 
Un" 
♦Potassium,  a  metal 
250        Potassii  acetas 

Liquor   potassii  ar- 
senitis;    see    under 
Arseni  trioxid 
Potassii  bicarbonas 

250       Potassii     bitartras, 
295  cream  of  tartar 

239       Potassii  bromidum 

Potassii  carbonas 
145       Potassii  chloras 
295  Trochisci    potassii 

chloratis 
250       Potassii  citras 

Liquor  potassii 
citratis 
293       *Potassii  cyanidum 
74       Potassii         hydrox- 
295         idum,  caustic 
potash 

Liquor  potassii  hy- 
droxidi,  4.5% 
*Potassa    cum    calce, 
Vienna  paste,  50% 
each    potash    and 
lime 
Plate      Potassi  et  sodii  tar- 
xviii         tras,  Rochelle  salt 
Pulvis    effervescens 
compoaitus,    Seid- 
litz  powder 
Potassii    hypophos- 
phis 
234       Potassii  iodidum 


insol. 
sol. 


si.  sol. 


V.  s. 
1.4 


1.85 
aim. 
insol. 


sol. 


gr.  1-5 

gr.  8-15 


gr.  5-15 


38 


spar, 
insol. 


£31^ 


gr.  1-2 


0.06-0.30 
0 . 50-1 


0.30-1 

extern. 

4-15 
extern. 


Antiperiodic;  Antipy- 
retic. 

.\s  solvent  for  uric 
acid;  in  gout  and 
allied  conditions. 

Used  externally  in 
chronic  eczema,  pso- 
riasis; with  atom- 
izer or  in  the  form  of 
sjTup  in  laryngitis, 
bronchitis,  catarrhs, 
phthisis. 


gr.  2-10        0.12-0. CO 
m5-15  0.30-1 


0 .  03-0 .  12     AUerative. 

0.03-0.12     Sedative  astringent: 

Acetate  used  as  seda- 
extern.  tive    application    to 

irritable     ulcers;     in 
skin  diseases;  astrin- 
extern.  gent    in     inflamma- 

tions  and   catarrhal 
discharges ;      intern- 
extern,  ally  in  hemorrhages, 
extern.  diarrheas,         gastric 
xilcer;  nitrate  as  deo- 
extern.  dorant  to  foul  ulcers; 
with  glycerin  as  as- 
tringent  to    fissured 
extern.           nipples;    oxide    used 
to  prepare  lead  plas- 
ter,     which      forms 
the    basis    of    many 
other   plasters. 

Cathartic:    Efficient  in 

torpor  of  the  liver; 
in  chronic  constipa- 
tion; the  resin  used 
in  laxative  pills. 


insol. 

sol. 

gr.  M 

0.007.5-0.0 

al. 

6^5 

2^9 

gr.  5^30 

0.30^2 

al. 
ac. 

X. 

al. 
X. 

2.8 

155 

1.5 
0.9 
11.5 

aim. 
insol. 
aim. 
insol. 
250 
insol. 
si.  sol. 

gr.  5-30 

3^-4 

gr.  5-60 
gr.  5-30 
gr.  2-10 

0.30-2 

2-15 

0.30HI 

0.30-2 

0.12-0.60 

al. 
si.  ac. 

0.6 

b1.  sol. 

gr.  2i  in 

each 

gr.  5-30 

f3l-8 

0.30-2 
4-30 

al. 
al. 

2 
0.9 

si.  sol. 
3 

gr.  >/50-'/,o 

0. 003-0. 00( 

al. 
al. 

■ITl-5-15 
weM  diluted 

0.30-1 
extern. 

al. 

0.9 

aim. 
insol. 

5i-i 

set  of  two 
powders 

8-30 

X. 

0.6 

9 

gr.  5-20 

0.30-1.30 

N. 

0.7 

22 

gr.  5-30 

0.30-2 

Alkali:  Potass,  hy- 
droxide is  caustic; 
liq.  pot.  hydrox.  di- 
luted and  the  carbo- 
nates are  used  as 
alkalies. 


The  salts  with  vege- 
table acids  also  act 
as  alkalies,  being 
converted  into  carbo- 
nates in  the  system, 
and  in  elimination 
they  are  diuretic;  in 
fevers,  rheumatism; 
to  produce  alkalin- 
ity of  the  urine;  bi- 
tartrate  and  Rochelle 
salt  are  cathartics; 
chlorate  is  detergent 
when  applied  to  mu- 
cous membranes  — 
poisonous  in  large 
doses;  best  used 
alone  as  may  form 
explosive  mixtures. 

Bromide  is  a  nerre 
sedative  with  same 
action  as  sodium 
bromide,  but  slightly 
less  efficient  and 
more  irritating. 

Iodide  is  alterative 
and    sialagogue;    in 


IXDEX  OF  DRUGS 


m 


Page  ; 


Drug. 


Reac- 
tion. 


Solubilit  J'  in 


Water,  i  Alcohol. 


Gm.  or  mil. 


Uses. 


250       Potassiinitras,  nitre,      X, 
293         saltpetre 
1-16       Potassiiperman-  X. 

162         ganas 

*Potassii  sulphas  X. 


2.8         aim. 
insol. 
13 .  o      decomp 

9  insol. 


gr.  5-15 
gr.  i-2 


Prepared   chalk;    see\ 
under  Calcium 

149   *Protargoi,  a  proteid 
compoimd  of  silver 
228     Pnmus  vorginiana  (p. 
serotina),  wild 
cherry  bark 
*Fluidestract\iin 
pruni  virginianae 
*Infusion 
Synipus 
Prussic  acid ;  see  Aci- 
dum     hydrocyani- 
cum^  dil. 
Pumpkin    seed;    see 

Pepo 
PjTethrum     (anacy- 
clus  p.,  root) 
Tinctura  pjTethri 
Pyrogallol,    pjTogal- 
lic  acid 
*Ointment,      2-3% 

114  ,  Pyroxj-Unum,  soluble 

guncotton 
227     Quassia        (picrasma 
escelsa,  wood; 
Tinctura 
*Infusion 


*Quercus,    white   oak 
(bark; 
*Fluidextractuni 
227     Quinina 

Quininae  bisulphas 
Quinina      dihj-dro- 

chloridum 
Quininse    hydrobro- 1 

midum 
Quininse  hydrochlo- 

ridum 
Quininae  salicylas 
Quininae  sulphas 
[     *Compound      tinc- 
'       ture  (, Warburg's; 
181        Quininae  et  ureae  hy- 
drochloridum  [ 

Quininae  tannas  I 

Red  precipitate:  see 
Hydrargyri  oxidum 
rubrum 
Resina  (from  turpen- 
tine), rosin 
Ceratima        resinae. 
basdicon  ointment 
145     Resorcinol,     resorcin 
Rhamnus     frangula. 
buckthorn;  see 
Frangula 
Rhatany;    see     Kra- 
meria 


sol. 


N.or 

i^T 

l.Z 

ac. 

insol. 

t 

al. 
ac. 
ac. 

N. 

X. 

al. 
X. 


X. 


1560 

9 

0.6 

40 


si.  sol. 
725 


0.9 
si.  sol. 


insol. 


0.9 


0.8 
23 
12 

0.9 

0.8 

14 
107 

2.4 
si."  sol. 

sol. 

0.9 


3i-i 


fa  1-2 
131-4: 


3i-l 


I'oi-l 
f51-2 


f3i-l 


gr.  1-20 


152-6 
gr.  1-15 


gr.  2-10 


0 .  30-1  tertiarj-         syphilis, 

asthma,  chronic 

0.03-0.12        bronchitis,      chronic 

rheumatism;  in  lead 

2-15  poisoning     to     pro- 

mote  elimination. 
Permanganate  as  ardi- 
septic;      nitrate      is 
diureiic;  nitre  paper 
as    a    fumigation  in 
asthma;   sulphate  is 
a  .mild  cathartic,  but 
seldom   used;   useful 
to  hasten  hardening 
of  plaster  of  Paris. 
.  Cyanide   is   in  action 
I     similar    to    hydrocy- 
anic acid;  poisonous. 

Antiseptic:  Applied  in 

1  to  5%  solutions. 

2-4  Bitter  tonic:     Se/Jaiite, 

by  virtue  of  hycUo- 
cyanic    acid,    which 

2—4  is  developed  in  the 

cold     infusion;       in 

30-60  pulmonary  diseases, 

4-15  coughs,  dyspepsia. 


1-4         li  Sialagogue;      Irritant: 

As   gargle;   as   sntiff 
extern.  in  chronic  catarrh. 
Caustic:    Poisonous. 

Externally     in     skin 

diseases. 

To   prepare   collodion 

and  xelltiloid. 
Bitter  tonic;      Anthel- 
mintic: In  atonic  in- 
1—4  digestion; infusion  as 
30-60  enema     to     remove 
thread-worms ;    con- 
tmns  no  tannin. 

Astringent:  Same  uses 

as  tannic  acid. 
1-1 

Quinine   is    the    chief 
remedy  used  in  ma- 
larial    fevers;      the 
sulphate      is      used 
0.06-1.30  j    mostly,  but  the  bi- 
1     sulphate      is      more 
'     soluble;   the    hydro- 
bromide,  hydrochlo- 
ride    and     dihydro- 
chloride   are  recom- 
8-25  mended    for     hypo- 

dermic use. 
0.06—1        Local  analgesic:     Has 
prolonged  action. 
0.12-0.60     The    tannate    is    less 
active,  but  is  nearly 
tasteless. 

In  plasters  and  oint- 
ments, 
extern.  Resin  cerate  is  applied 
to  bruises,  ulcers,  etc. 
0.12-0.30  -intiseptic:  May  use 
internanj-;  in  per- 
tussis, 2%  solution 
used  as  a  spray  to 
the  upper  air  tract. 


Soluble  in  25  parts  of  a  mixture  of  3  vols,  ether  with  1  voL  alcohol. 


320 


INDEX  OF  DRUGS 


Page 

Reac- 

Solubility in    '                   Dose. 

Uses. 

in                      ijiug. 

tion. 

1 

text. 

Water.  Alcohol. 

Gm.  or  mil. 

Plate    Rheum,  rhubarb   (r. 

gr.  3-30 

0.20-2 

Astringent;     Cathartic. 

xviii         officinale,  root) 

Small  doses  tonic  to 

Extractum  rhei 

gr.  3-15 

0.20-1 

intestinal  tract;  lar- 

Fluidextractum 

m3-30 

0.20-2 

ger  doses  safe,  effi- 

Pilulae compositse 

1-3  pills 

cient  laxative;  cath- 

Puh-is compositus 

3i-i 

1-4 

artic  effect  apt  to  be 

Syrupus 

Syrupus  aromatieus 

':::] 

child  31 

child  4 

followed  by  consti- 
pation   unless    com- 

Tinctura 

f3i-2 

2-8 

bined      with      more 

Tinctura  aromatica 

f31-l 

1^ 

powerful  agents,  as 
in  compound  pill;  its 
astringency  makes  it 
a  valuable  laxative 
in  diarrheas. 

165 

♦Rhigolene  (from  pe- 
troleum) 
Rochelle     salt ;      see 
Potassii    et    sodii 
tartras 

Used  as  local  anal- 
gesic. 

*Rhus  glabra,  sumach 

3i-l 

1-4 

Astringent:      As   mild 

(fruit) 

astringent,  gargle,  or 

♦Fluidextractum 

f3i-l 

1-4 

lotion. 

rhois  glabra 

♦Rosa         damascena, 

damask  rose 

285 

Oleum  rosse,  otto  of 

rose 
Rosa  centifolia 
Aqua  rosse 
Aqua  ros£e  fortior 
Unguentum      aquse 

rosse,  cold  cream 

Rosa  gallica,  red  rose 
(dried  petals) 

N. 

insol. 

si.  sol. 

Flavoring  agent:  Per- 
fume. 

Rose  water  as  vehicle 
or  flavor. 

Cold  cream  to  soften 
the  skin;  applied  to 
chapped  hands. 

Flavoring  agent. 

Fluidextractum 

f3i-i 

1-4 

Fluid  extract  as  vehi- 

Mel., honey  of  rose 

... 

freely 

cle;  the  honey  locally 
as  mouth- wash. 

♦Rubus,    blackberry 

Astringent:      In   diar- 

(bark of  root) 

rheas. 

♦Fluidextractum 

f3§-2 

2-8 

ruhi 

♦Syrupus 

£31-2 

4-8 

Saccharine;    see  Ben- 

zosulphinidum 

30     Saccharum,         cane- 

N. 

0.5 

170 

Sweetening  agent;  Pre- 

264         sugar 

servative. 

Syrupus 

Syrup  as  vehicle. 

30     Saccharum  lactis, 

N. 

'5' 

aim. 

The    hardness    of    its 

sugar  of  milk 

insol. 

particles      make      it 

Sage;  see  Salvia 

useful  in  preparing 
triturations. 

SaUcinum,         salicin 

N. 

23.6 

88.5 

gr.  5-30 

0.30-2 

Tonic;      Antiperiodic: 

(from  several  spe- 

In rheumatism,  ma- 

cies   of    salix    and 

larial  fevers. 

populus) 

Salol;     see     phenylis 

salicylas 

Saltpetre;  see  Potas- 

sii nitras 

♦Salvia  (s.  officinalis) 

3i-l 

1^ 

Astringent:       Infusion 

sage  leaves 

1 

as  gargle,  often  with 
alum. 

35     Santoninum       (from 

N.       insol. 

43 

gr.  i-1 

0.015-0.06 

Anthelmintic:     To  de- 

1     santonica),       san- 

chUd 

stroy  round  worms. 

1       tonin 

used  cautiously. 

29     Sapo,    white   Castile 

al.        V.  B. 

V.  8. 

gr.  5-15 

0.30-1 

Seldom  internally  ex- 

117        soap 

cept   in   suppository 

Linimentum 

extern. 

or     pill;     powdered. 

117  1  Sapo      mollis,      soft 

al. 

V.  8. 

v.'s.     '        

extern. 

used  as  an  alkali  and 

1       soap,  green  soap 

detergent     in     denti- 

1    Linimentum.saponis 

al. 

extern. 

frices;   soft  soap   as 

mollis 

antiseptic;  in  diseases 

of  the  skin. 

237  i  SarsaparillaCroot) 

1 



Tonic;  Alterative:  Has 

Fluidextractum 

'.'.'.       '.'.'.    !     fji-i 

2-4 

very     feeble     medi- 

Fluidextractum 

f3i-l 

2-4 

cinal    powers;    used 

comp. 

i     chiefly  as  vehicle  for 

Syrupus  comp. 

..     1     ...     1     ...     i      f5i-l 

8-30 

[     stronger   alteratives. 

IXDEX  OF  DRUGS 


321 


Page 


Drug 


Reac- 
tion. 


Solubility  in 


Dose. 


Water.  AlcohoLj 


Uses 


Gm.  or  mil. 


250 
252 


223 
293 


Plate 
xviii 


254 


255 


61 


Sassafras  (s.  varii- 
folium,  bark  of 
root) 

Oleum  sassafras 
Scilla,     squill     (urgi- 
nea  maritima, 
bulb) 

Acetum  scilla? 

Fluidestractum 

Syrupus 

Syrupus  comp.,  hive 
syrup  (0.2%  tartar 
emetic) 

Tinctura 
Scopolaminse   hydro- 
broraidum,     hyos- 
cine  hydrobromide 
(from     various 
plants  of  the  Solan- 
aceae,    but    chiefly 
from   the   seed    of 
hyoscyamus      and 
stramoniiim) 
Senega   (polygala  s., 
root) 

Fluidestractum 
senegse 

Syrupus 
Senna   (cassia  acuti- 
f  olia  and  c.  angusti- 
folia,    leaves) 

Fluidestractum 

Infusum  comp. 

Pulvis  glycyrrhizse 
compositus 

Syrupus 

Serum  antidiphtheri- 
cum,  diphtheria 
antitoxin 

Serum  antitetanicum, 
tetanus  antitoxin 


61     S 


61 
251 


118 


118 
127 


Sinapis    alba,    white 
mustard  seed 

Sinapis   nigra    Garas- 
sica   nigra) ,    black 
mustard  seed 
Emplastnim  sinapis, 

mustard  paper 
Oleum  sinapis  vola- 
tile 
*Flour   of   mustard 
is     a     mixture     of 
white  and  black 

Slippery      elm;      see 
fjlmus 

Soap;  see  Sapo 

'Sodium,  a  metal        j 

Sodii  acetas 

Sodii    arsenas;     see 

under  Arseni 
Sodii  benzoas 

Sodii  bicarbonas 
Trochisci  sodii  bi- 
carbonatis 
Sodii  bisulphis;   see 
under     Acid,     sul- 
phurosum 
Sodii   boras,    borax 
*Liquor  sodii  bora- 
tis       compositus, 
DobeU's  solution 


1.5 


20 


insol. 


al.  or 
X. 
al. 


N.  or 

al. 
al. 


0.8 

1.8 
10 


sol. 


19 


61 
inaol. 


insol. 


mi-5 


mio-.3o 
mi-o 

f5i-i 
m5-30 


m5-30 

gr.  I/mo 


gr.  10-20 

mio-20 

31-2 

iZi-2 
f51-4 
3i-2 

fBi-l 


1-      31-4 


lUs- 


1-4  The  warm  infusion  is 

diaphoretic;  regarded 
as     alterative,     but 
0.06-0.30        has  feeble  power. 

Diuretic;  Expectorant: 

In  large  doses  emetic; 
like  digitalis,  it 
strengthens  pvilse 
and  increases  excre- 
tion of  urine;  in 
bronchitis ,  croup ; 
the  compound  sjTup 
cautiously  with  chil- 
dren. 
Mydriatic:  Resembles 
atropine  and  hyos- 
cyamine  in  action  and 
uses;  with  morphine 
to  induce  "twilight 
sleep." 


0.60-2 

0.06-0.30 

1-4 

0.30-2 


0.30-2 
0.0003 


0 . 60-1 . 30 
0.60-1.20 


2-8 
4-8 


2-8 
30-120 

2-8 

8-30 


gr.  10-30  0.60-2 


gr.  5-30         0 .  30-2 


gr.  3  in 
each 


gr.  5-30 


Stimulant  expectorant; 
Diuretic:  In  chronic 
bronchitis,  asthma, 
croup;  often  com- 
bined with  squiU. 

Cathartic:  Efiacient 
and  safe  in  any  con- 
dition, except  intes- 
tinal inflammation: 
the  confection  and 
compound  licorice 
powder  are  mild, 
useful  for  children 
and  in  pregnancy. 

In  diphtheria,  hj-po- 
dermically,  to  antag- 
onize poison  of  the 
disease. 

In  tetanus  (lockjaw) 
hjTpodermically  to 
antagonize  poison  of 
the  disease;  it  is  most 
successfully  used  as 
a  prophylactic  to 
prevent  development 
of  tetanus. 

Rubefacient;  Irritant 
emetic:  Mustard 

owes  its  irritant  pro- 
perty to  the  vola- 
tile oil,  which  is  de- 
veloped in  the  pres- 
ence of  cold  water. 
0.0075-.015  The  volatUe  oil  is 
antiseptic,  but  very 
irritating. 


The  general  action 
and  uses  of  sodium 
salts  are  similar  to 
those  of  potassium; 
as  alkalies  they  are 
less  disturbing;  be- 
ing better  tolerated 
by  the  system  they 
are  more  slowly  eli- 
minated, therefore 
less  diuretic. 

Liq.  sod.  hydros.,  the 
acetate  and  carbon- 
ates as  alkalies,  the 
bicarbonate  more 
than  all  others  for 
internal  use. 


4-15 


extern. 


0.20  in 
each 


0.30-2 
extern. 


4-'    21 


322 


INDEX  OF  DRUGS 


Page 

Drug. 

Reac- 
tion. 

Solubility  in 

Dose. 

Uses. 

in 
text. 

Water. 

Alcohol. 

Gm.  or  mil. 

239 

Sodii  bromidum 
Sodii  cacodylas;  see 

under    Arseni    tri- 

oxidum 

N. 

1.1 

16 

gr.  5-60 

0.30-4 

Benzoate   and   borate 
are     antiseptic;     the 
former  in  cystitis,  to 
prevent    decomposi- 

Sodii carbonas  mon- 

al. 

3 

insol. 

gr.  5-10 

0.30-0.60 

tion  of  urine;  borax 

ohydratus 

as     mouth-wash     in 

48 

Sodii        chloridum, 

N. 

2.8 

aim. 

5J-4 

2-15 

thrush. 

221 

common  salt 

insol. 

Bromide    is     sedative; 

221 

Liquor  sodii  chlo- 
ridi  physiologicus, 
normal  salt  solu- 
tion 

N. 

1-2  pints 

500-1000 

large  doses  by   ene- 
ma to  control  obsti- 
nate vomiting  due  to 
reflex    causes;    most 

Sodii  citras 

al. 

1.3 

insol. 

gr.  5-30 

0.30-2 

efficient    remedy    in 

161 

♦Sodium  dioxide 

al. 

sol. 

extern. 

epilepsy;  in  infantile 
convulsions,      head- 

74 

Sodii     hydroxidum, 

al. 

0.9 

V.  8. 

aches,      fevers,      in- 

295 

caustic  soda 

somnia,  nervousness. 

Liquor     sod.     hy- 

al. 

TR5-15 

0.30-1 

hysteria;  sedative  to 

droxidi,  4.5% 

diluted 

sexual  organs. 

Sodii  hypophosphis 

N. 

1 

25 

gr.  5-20 

0.30-1.30 

Chloride     in     normal 

234 

Sodii  iodidum 

al. 

0.5 

2 

gr.  5-30 

0.30-2 

(O.SS'c)   solution  as 

Plate 

Sodii  nitris 

al. 

1.5 

si.  sol. 

}     gr.  1-3 

0.06-0.20 

cleansing    lotion    in 

xiii 

Sodii  perboras 

al. 

sol. 

diphtheria,  nasal  ca- 

Sodii phenolsulpho- 

N. 

4,2 

146 

gr.  1-10 

0.06-0.60 

tarrh,      pharyngitis. 

nas 

and    hypodermically 

Plate 

Sodii  phosphas 

al. 

2.7 

insol. 

gr.  5-51 

0.30-30 

or  intravenously    as 

xviii 

restorative. 
Dioxide    is    a    caustic 
and  bleaching  agent; 
in     saturated     solu- 
tion to  bleach  teeth; 

135 

Sodii  salicylas 

ac. 

0.9 

9.2 

gr.  5-30 

0.30-2 

perborate     also      as 
bleaching  agent. 
Hypophosphiteis  toiiic. 

Phosphate    and    sul- 
phate are  laxative. 
Nitrite  has  same  uses 

Plate 

Sodii  sulphas,  Glau- 

N. 

2 

insol. 

31-S 

4-30 

as  nitroglycerin. 

xviii 

ber's  salt 
Sodii    sulphis;     see 

under  Acidum  sul- 
phurosum 

Sodii  et  potassii  tar- 
tras;    see    Potassii 
et  sodii  tartras 
Sodii  thiosulphas 
(hyposulphite) 
See  under  Acid 
sulphurosum 
Soda  powders,  effer- 
vescing     powders, 
consist       of       one 
powder  of  bicarbo- 
nate of  sodium  and 
one  of  tartaric  acid, 
taken  together 

Salicylate     has     same 
uses  as  salicylic  acid. 

Phenolsulphonate      is 
used    internally    for 
same     purposes     as 
carbolic  acid. 

143 

♦Sozoiodol,  sozoiodolic 
acid,  53%  iodine 
Spanish      flies;       see 
Cantharis 

ac. 

si.  sol. 

extern. 

Antiseptic:  In  solution 
or  as  dusting  powder. 

Sparteinse        sulphas 

N. 

1.1 

3 

gr.  V.o-l 

0.006-0.06 

Heart  stimulant;  Diu- 

(from scoparius) 

retic:      Acts      more 

Spearmint;  see 

promptly  than  digi- 

Mentha viridis 

talis. 

Spermaceti;  see  Ceta- 

ceum 

SpiritUB    aetheris    ni- 

trosi;      see     under 

jEther,  nitrous 

Squill;  see  Scilla 

Starch;  see  Amylum 

Storax;  see  Styrax 

296 

Stramonii  folia    (da- 
tura s.,  leaves) 

gr.  1-3 

O'.  06-0. 20 

Narcotic;         Anodyne: 
Leaves    as    fumiga- 

Extractum stra- 

gr. i-i 

0.008-0.015 

tion  in  asthma;  sim- 

monii 

ilar    to    belladonna; 

Tinctura 

m5-30 

0.30-2 

as  antispasmodic  and 

Unguentum 

extern. 

anodyne   in    asthma, 
chorea, neuralgia,dys- 
menorrhea;  ointment 

to  painful  ulcers. 

IXDEX  OF  DRUGS 


323 


in     I 
text. 


Drug. 


Reac- 
tion. 


Solubility  in 


Dose. 


Uses. 


Water.  Alcohol. 


Gm.  or  mil. 


177 
216 
223 
Plates 
iv,  xi 
294 

133 


246 
246 


Plate 
xviii 


253 


62 
296 
141 


63 


'Strontium,  a  metal 
Strontii  bromidujn 
Strontii  iodidum 
Strontii  salicylas 


Strophanthus  (s. 

Komb§,  seeds) 
Tinctura  stro- 

phanthi 
Strychnina  (from  mix 

vomica) 

Strychnine  nitras 
StrychninEe  sulphas 

StjTas,  storax 
Tinctura      benzoini 

composita,   8%    of 

storax 
Sugar;  see  Saccharum 
Sugar    of    lead;     see 

Plumbi  acetas 
Sugar    of    milk;    see 

Saccharum  lactis 
Sulphonethylmeth- 

aniim,  trional 
Sulphonmethanum, 

sulphonal 
Sulphur  lotum 

■washed  sulphur 
S.  prfficipitatum 
S.  subUmatum,  flow- 
ers of  sulphur 
Unguentum         sul- 
phur is,  15% 
Sulphuric    ether;    see 

^ther,  ethylic 
Sum^ach;     see     Rhus 

glabra 
Suprarenalum  siccum, 

dried       suprarenal 

glands:    see   under 

Adrenahn 
Sweet    almond;     see 

Amygdala  dulcis 
Sweet  birch   oil;   see 

Oleum  betulae 
Sweet  spirit  of  nitre; 

see    under    iEther, 

nitrous 
*Tanacet\im,  tansy  (t. 

•^-ulgare,  leaves  and 

tops) 
*Volatile  oil 
Tartar     emetic ;     see 

Antimonii    et    po- 

tassii  tartras 
Terebenmn         (from 

turpentine) 
*Terebinthina,        tur- 
pentine,   an    oleo- 

resin  from  pine 
Oleum  terebinthinse 


Oleum  t.  rectifica- 
tum 

Emiilsum  olei  tere- 
binthinse, 15% 

Linimentum,  35% 


i  Terpini  hydras,   ter- 

pin  hydrate 
*Tetronal 
*Theobroma   cacao 

(seeds) 

Oleum  theobroma- 
tis,  cacao  butter 


0.35 
0.2 
19 


6240 


42 
32 


sol. 
sol. 
61 


gr.  1-60 
gr.  5-30 
gr.  5-30 


0.06-4 
0.30-2 
0 . 30-2 


m2-15 


0.12-1 


150 

81 


[•gr.  '/60-V.o  0.001-.006 


insol.      1  warm 


gr.  5-20 
m5-60 


0.30-1.30 
0.30-1 


N. 

200 

'     sol. 

N. 

365 

60 

N.    ] 

N.    [ 

ac. 

insol. 

1  si.  sol. 

;  in  ab- 
solute 
alcohol 

gr.  5-30        0.30-2 

0 . 30-2 


gr.  o- 


30 


3i-2 


1-8 


extern. 


gr.  1-10        0.06-0.60 


N.       si.  sol.  '       3 
ac.        insol.        sol. 


N.  or 

insol. 

5 

si  ac. 
N. 

insol. 

5 

N. 

200 

13 

450 
... 

sol. 

3^1 

mi-3 

m5-i5 


TTlo-15 


f3f-2 


Salts  of  strontium  act 
as  do  those  of  other 
earth  metals;  they 
are  not  poisonous, 
but  are  believed  to 
aid  nutrition. 

Heart  stimulant;  Diu- 
retic: Effect  upon 
heart  similar  to  that 
of  digit  aUs. 

BMer  tonic;  Xerze 
stimulant:  Action 
and  uses  same  as 
those  of  nux  vom- 
ica, which  drug  it 
represents  fully. 

Expectorant;  Antisep- 
tic: In  catarrhs, 
purulent  mucous 
discharges;  to  pre- 
serve fats. 


Hypnotic:  Both  are 
less  depressing  and 
safer  than  chloral. 

j  Laxative;       Alterative: 

I  In  chronic  eczema, 
psoriasis,  and  other 
skin  diseases,  inter- 
nally and  externally; 

,  very  effectual  exter- 
nally for  scabies; 
washed  s.  most  suit- 

1     able  for  internal  use. 


0.06-0.20 


0.30-1 


Emmenagogue;  An- 
thelmintic: Danger- 
ous in  large  doses. 


i  Stimulant   expectorant: 
In     cough,     chronic 
bronchitis,  hay 
asthma. 


gr.  2-10 
gr.  15-30 


insol. 


100 


Anthelmintic. 

Stimulant:  Diuretic: 
Externally  vesicant; 
internally  in  t>-phoid 
conditions,  intestinal 
ulceration  and  hem- 
orrhages; the  crude 
i  French  oil  in  phos- 
phonis  poisoning. 
0 .  12-0 .  60  Antiseptic;  Expecto- 
rant;    in  bronchitis. 

Hypnotic. 

To  prepare  chocolate. 


In  preparing  supposi- 
tories. 


2-15 
0.30-1 


2-8 
extern. 


1-2 


324 


INDEX  OF  DRUGS 


Page 

Drug. 

Reac- 
tion. 

Solubility  in 

Date. 

Uses. 

m 
text. 

Water. 

Alcohol 

Gm.  or  mil. 

223 

^Theobromine 

si.  sol. 

sol. 

gr.  2-10 

0.12-0.60 

Diuretic:      Similar   to 

251 

Theobromine        and 
sodium    salicylate, 
diuretin 

al. 

1 

si.  sol. 

gr.  5-15 

0.30-1 

caffeine,  but  less 
stimulating  to  cere- 
brum; very  efficient 
as  diuretic. 

*Thiosinamine     (from 

si.  sol. 

sol. 

gr.  h-2 

0.03-0.12 

Resolvent;      Antiseptic; 

vol.  oil  of  mustard) 

To  soften  scar  tissue. 

♦Thymus        vulgaris, 

3i-i 

1-4 

Aromatic        stimulant: 

thyme  (leaves) 

Mostly   as  infusion; 

140 

Oleum  thy  mi 

N. 

insol. 

2 

mi-5 

0  06-0.30 

oil     as     carminative. 

140 

Thymol 

N. 

1010 

1 

gr.  1-30 

0.06-2 

Antiseptic:  Internally 
in  hookworm  disease. 

141 

Thymolis    iodidum, 
aristol,  43%  iodine 

insol. 

675 

extern. 

Antiseptic:  Substitute 
for  iodoform. 

253 

Thyroideum   siccum, 
dried  thyroid  gland 

gr.  1-5 

0.06-0.30 

To  supply  the  thyroid 
substance,  as  in 
myxedema,  cretinism 
and  obesity;  in  some 
cases   of   goitre. 

Tragacantha,       gum 

part. 

insol. 

Excipient    in    making 

tragacanth 

pills     and     troches; 

Mucilago         traga- 

freely 

mucilage  as  vehicle. 

eanthse 

Tricresol,  see  Cresol 

Trinitrophenol,  picric 

ac. 

78 

12 

gr.  i-2 

0.03-0.12 

Mostly  externally;  as 

acid 

application,  in  weak 

Trional;  see  Sulphon- 

solution,   to  burns. 

ethyhnethanum 

Tully's    powder;    see 

under  Morphina 

181 

*Tropacocaine  hydro- 
chloride         (from 
"small-leaved 
coca") 
Turpentine;  see  Tere- 
binthina 

al. 

sol. 

sol. 

gr.  i-1 

0.015-0.06 

Local  anesthetic:  Sim- 
ilar to  cocaine,  but 
less   toxic. 

90 

Ulrnus      (u.      fulva), 
slippery    elm     (in- 
ner bark) 
*Mucilago  ulnii 
*Decoction 
Urotropin;  see  Hexa- 
methylenamina 

freely 
freely 

Demulcent;  Emollient: 
As  poultice;  intern- 
ally in  pharyngitis, 
diarrhea,  dysentery, 
cystitis,  irritation  of 
urinary  tract. 

251 

Uva   ursi,    bearberry 
(arctostaphylos   u. 
u.,  leaves) 
Fluidextractum  uvse 

3i-l 
f3i-l 

1-4 
1-4 

Astringent;  Diuretic: 
In  chronic  disorders 
of  urinary  tract. 

ursi 
Valeriana,      valerian 

gr.  10-30 

0.60-2 

Stimulant;     Antispas- 

(v  officinalis,  root) 

modic:     In  hysteria, 

Tinctura  Valerianae 

f3i-l 

1-4 

chorea,     and     other 

Tinctura  v.  ammo- 

f3i-l 

1-4 

functional      nervous 

niata 

disorders,  headaches; 

Vaseline;    see    Petro- 

in typhoid  conditions. 

latum 

Veratrina  (from  sab- 

al. 

si.  sol. 

2.3 

gr.  >/jo-V.o 

0.002-0.006 

Has    been    employed 

adilla) 

externally      in   neu- 

*01eatum veratrinae. 

extern. 

ralgia   and   rheuma- 

2% 

tism,  but  rarely  used 

Unguentum,  4% 

extern. 

internallj'. 

239 

Veratrum  viride,  Am. 
hellebore  (root) 

gr.'  i-30 

0.06-2 

Sedative:  In  action 
similar    to    aconite; 

Fluidextractum  ver- 

mi-30 

0.06-2 

in     sthenic     fevers. 

atri  viridis 

mania,        puerperal 

Tinctura 

m5-30 

0.30-2 

convulsions. 

Veronal 

ac. 

170 

v.  s. 

gr.  5-15 

0.30-1 

Hypnotic. 

Viburnum     pninifol- 



Tonic;     Uterine    seda- 

ium,    black     haw 

tive:      Used   to   pre- 

(bark) 

vent     abortion ;     in 

Extractum    viburni 

gr.  5-15 

0.30-1 

dysmenorrhea. 

prunifolii 

Fluidextractum 

f3i-l 

1-4 

Vienna      paste;      «ee 

under  Potassium 

*Vinum  album,  white 

ac. 

Stimulant:    Wines  de- 

wine (8.5  to  15% 

pend      largely      for 

by    vol.    absolute 

their  medicinal  value 

alcohol) 

upon  alcohol. 

IXDEX  OF  DRUGS 


325 


Page 

in 
test. 


Drug. 


Reac- 
tion. 


Solubility  in 


Water.  'Alcohol. 


Dose. 


Gm.  or  mil. 


Uses. 


*Vuium   rubrum,   red 

ac. 

Use  same  as  of  vinum 

•srine  (8.5  to  15% 

[ 

album. 

!       by    vol.     absolute              \ 

alcohol)                                 i 

1  Warburg's    tincture; 

1       see  under  Quinine 

1  Wax;  see  Cera 

j  Whiskey;    see   under 

Alcohol 

White  oak;  see  Quer- 

Zinc  salts  are  astrin- 

cus                                        1 

gent,    and    in    large 

1  White  precipitate;  see 

[ 

doses    irritant;    sul- 

1      Hydrargjnim  am- 

[ 

phate     and    acetate 

moniatum 

are  most -valuable  as 

Wild      cherry;        see 

astringents;  in  weak 

Prunus  virginiana 

solution  to  inflamed 

Wine,  see  Vinum 

mucous  membranes, 

Wiatergreen;          see 

conjunctivitis      ure- 

Gaultheria 

thritis,  vaginitis,  ca- 

Witch-hazel; see                        [ 

tarrhs,  etc.;  in  large 

Hamamelis 

doses  they  are  emetic 

Wood  spirit ;  see  Alco- 

the  sulphate  being  a 

i       hoi,  methyl 

mild,     efficient    and 

i  Wood  tar;  see  Pix 

prompt    emetic    for 

Yellow  wash;  see  un- 

any   age;     oxide    is 

der  Hydrargyrum 

used  externally  as  a 

Zincum,  zinc,  a  metal 

sedative    to    wounds. 

Zinci  acetas 

N.  or 
si.  ac. 

2.3 

30 

gr.  1-2 

0.03-0.12 

ulcers    and    in    dis- 
eases of  the  skin. 

80  '     Zinci  chloridum 

ac. 

0.25 

1.3 

extern. 

Chloride  is  a  powerful 

105  !       Liquor  zinci  chlo- 

escharofic    and    anti- 

147          ridi,  50% 

septic. 

296 

Phosphide  and  valer- 

106      Zinci  iodidum 

ac. 

Y.  S. 

_v.  s. 

gr.  1-3 

0.06-0.20 

ate  in  nervous  con- 

106 [     Zinci  osidum 

insol. 

insol. 

gr.  1-5 

0.06-0.30 

ditions,  hysteria. 

Unguentum     zinci 

extern. 

Iodide  is  used  mostly 

'           oxidi,  20% 

as  an  alterative  exter- 

Zinci phenolsulpho- 

ac. 

1.6 

1.8 

gr.  1-3 

0.06-0.18 

nal  remedy:  may  be 

nas 

used  incleaningteeth 

*Zinci  phosphidum 

.... 

insol. 

insol. 

gr.  Vkt-i/s 

0.006-0.02 

and  in  gingivitis. 

jQ-  !     Zinci  sulphas 

ac. 

0.6 

insoL  < 

gr.  i-2 
gr.  10-30 

0.03-0.12 
0.60-2 

Astringent. 
Emetic. 

251  1     Zinci  valeras 

ac. 

70 

22 

gr.  i-3 

0.03^.20 

1  Zingiber,    ginger    (z. 

gr.  5-15 

0.30-1 

Aromatic       stimulant: 

officinale,  root) 

Condiment;   as   car- 

j    Fluidextractum 

1115-15 

0.30-1 

minative     in     flatu- 

zingiberis 

lence  :    mild    stimu- 

Syrupus 

f51-4 

4-15 

lant  in  atonic  indi- 

Tinctura 

f3i-i 

1-4 

gestion:    the    syrup 

Oleoresina 

•■     i 

...     1 

mi-i 

0.01.3-0.06 

as  vehicle. 

GENERAL  INDEX. 


Some  drugs  not  listed  in  the  General  Index  may  be  found  in  the  Index  of  Drugs. 


A.  C.  E.  MIXTURE,  212 

Abbreviations,  287 
Abortive  poisons,  290 
Abscess,  65,  155 

alveolar,  76,  81 
Absorption  of  medicines,  42,  44,  49 
Acacia,  90,  297 
AcetaniUd,  143,  240,  297 

compoimd  powder  of,  240 
poisonous  effects  of,  240 
Acetozone,  161,  297 
Acetphenetidinum,  240,  297 
Acetum,  24 
Acid,  acetic,  24,  297 

glacial,  73,  297 
acetylsaUcylic,  241,  297 
arsenous.     See  Arsenic, 
benzoic,  134,  286,  297 
boracic,  126,  297 
boric,  126,  297 
carboUc,  75,  127,  291,  317 
as  antiseptic,  127 
as  caustic,  75 
poisoning^  76,  129,  291 
chromic,  80,  306 
cirmamic,  133,  297 
citric,  230,  297 
gaUic,  97,  108,  297 
hydrochloric,  71,  291,  297 

dilute,  229,  298 
hydrocyanic,  228,  239,  291 

dilute,  239,  298 
lactic,  73,  298 
nitric,  71,  291,  298 

dilute,  229 
nitrohvdrochloric,  71,  291,  298 

dilute,  230 
oxalic,  291,  298 
phosphoric,  dilute,  231,  298 
prussic,  291,  298 
sahcylic,  134,  286,  298 
sulphuric,  71,  291,  298 
aromatic,  230,  298 
dilute,  230,  298 
sulphurous,  162,  298 
tannic,  33,96,  298 
glycerite  cf,  93 
tartaric,  230,  298 


i  Acid,  trichloracetic,  73,  298 
Acids,  mineral,  71,  291 

poisoning  by,  72,  291 

mineral,  dilute,  229 

organic,  73 

vegetable,  230 
Aconite,  110,  239,  291,  298,  Plate  XIV. 

antagonists  to,  269 

tincture  of,  64,  65,  243 
Aconitine,  239,  291,  298 
Action  of  medicines,  19,  50 

chemical,  52,  70,  159 
electrical,  51 
physical,  50 
Actol,  149,  300 
Actual  cauter5^  88 
Adeps  lanse,  91,  299 
Adjectives,  declensions  of,  274 
Administration  of  medicines,  41 
Adrenalin,  107,  175,  254,  299 

as  an  aid  to  cocaine,  108,  175 

as  hemostatic,  108 
.Ether.    See  Ether. 

.^thyhs  chloridmn.     See  Ethyl  chloride. 
Air  embolism,  45 
Albolene,  90 
Albumin,  90,  299 

as  antidote,  77 
Alcohol,  absolute,  98 

as  anesthetic,  216 

as  antidote,  77 

as  astringent,  99 

as  preserv^ative,  265 

as  solvent,  100,  264 

as  stimulant,  178,  219 

dehydrated,  98 

diluted.  98 

ethvhc;  98,  131,  216,  219,  279, 
Plate  Ylll. 

germicidal  power  of,  131,  184 

methyhc,  100,  299 
Alkalies,  il5 

caustic,  73 
Alkahm'ty  of  blood  in  anesthesia,  188 
Alkaloids,  32 

artificial,  33 

incompatibihtv  of,  34 

of  opium,  246,-248 

solubilitv  of,  33 
Aloes,  299,  Pkte  XVIII. 


328 


GENERAL  INDEX 


Aloin,  35,  299,  Plate  XVIII. 
Alpha-eucaine,  167,  note 
Alteratives,  37,  232 
Alum,  102,  299 
as  emetic,  251 
burnt,  80,  103,  299 
Alumen,  102,  299 

exsiccatum,  80,  103,  239 
Alveolar  abscess,  76,  81.     See  Abscess. 
Alypin,  179 

Ammonia,  49,  220,  291,  299 
spirit  of,  220 

aromatic,  178,  216,  220,  300 
water  of,  220 

stronger,  73,  291,  300 
Ammonium  bromide,  300,  Plate  XV. 
carbonate,  220,  291,  300 
chloride,  91,  252,  300 
Amygdalin,  35,  228 
Amyl  nitrite,    176,  225,    294,    300,  Plate 

XIII. 
Analgesia,  164 
Analgesics,  38,  164 
local,  164 

paralyzant,  165,  167 
refrigerant,  164,  165 
Anesthesia,  164,  186,  191,  Plate  V. 
anemia  in,  187,  197 
asphj^xia,  188,  196 
at  night,  198 
autointoxication  in,  196 
blood  changes  in,  187 

pressure  in,  188 
contraindications  to,  195 
dangers  of,  193,  206 
local,  164 

pharyngeal  method,  202 
precautions  concerning,  197 
preparation  of  patient  for,  197 
pulse  in,  184 
pupils  in,  192,  194 
recovery  from,  195 
respirations  in,  191,  193,  212 
responsibility  in,  198 
resuscitation  from,  212 
stages  of,  190 
Anesthetics,  39,  164,  185 
action  of,  187,  Plate  V. 
blood  changes  induced  by,  187 
comparative  safety  of,  210 
general,  185 
historv  of,  185 
local,  164 
mixtures  of,  212 
responsibility  for  use  of,  198 
Animal  charcoal,  152,  304 
purified,  152,  304 
drugs,  253 
Anodyne,  39 
Antacids,  38,  115 
Antagonism  of  drugs,  269 
Antagonists  of  cocain,  176,  270,  Plate  IV. 
Anthelmintic,  40 

Antidiphtheric  serum,  54,  254,  321 
Antidote,  physiologic,  269 


Antidotes,  chemical,  70,  72.     See  Table 

of  Poisons  and  Antidotes. 
Antimonii     et     potassii     tartras,     251, 

300 
Antipyretics,  39,  240 
Antipyrine,  107,  240,  245,  300 
Antiseptics,  38,  39,  124 
Antiseptol,  143,  306 
Antispasmodic,  39,  245 
Antitetanic  serum,  255,  321 
Antitoxin,  39,  54,  254,  255,  289.  300 
Aphthous  stomatitis,  146 

ulcers,  76 
Apomorphine,  33,  252,  300 
Apothecaries'  weights,  275 
Apothesine,  167,  179,  183 
Aqua,  24 

ammonia;,  24,  220,  291,  299 

fortior,      24,       73,      220,      291, 
300 
cinnamomi,  138,  306 
creosoti,  131,  287,  307 
fortis,  71 
regia,  71 
Argenti  citras,  149,  300 
lactas,  149,  303 
nitras,  78,  103,  149,  296,  300 
dilutus,  78,  300 
fusus,  78,  300 
mitigatus,  78,  300 
Arg>'ria,  78,  150 
Argyrol,  149 
Aristol,  141,324 
Arsenic,  82,  232,  291,  301 
as  alterative,  232 
antidote  tc,  291 
action  of,  84 
as  devitalizer,  83 
as  escharotic,  82 
combinations  with,  85 
iodide,  234,  301 
poisoning  by,  87,  88,  291 

local,  87 
rules  for  applying,  84 
trioxide,  82,  232,  291,  301 
Ar.«enical  paste,  85 
Arsenous  acid,  82,  232,  291,  301 

solution  of,  232 
Arteriosclerosis,  122 
Artificial  alkaloids,  33 

respiration,  178,  213,  214 
Howard  method.  214 
Laborde  method,  215 
Schiifer  method,  214,  215 
Sylvester  method,  213 
Asepsis,  125 
Asphyxia,  188,  196,  290 
Aspirin,  241,  297 
Asthenia,  290 
Astringents,  38,  94 
coagulant,  96 
mineral,  100 
vascular,  106 
vegetable,  96 
Atoxyl,  301 


GENERAL  INDEX 


329 


Atropin,  32,  177,  222,  291,  301,  Plates  IV 
and  IX. 
antagonists  to,  269 
in  mercurialism,  152 


B 


Bacterin,  54 

Balsamic  resins,  29 

Balsam  of  Peru,  134 

Balsams,  29 

Belladonna,  222,  291,  302,  Plate  IX. 

in  mercurialism,  152 
Benzin,  265,  302 
Benzoic  acid,  134,  286,  297 
Benzoin,  133,  302 

tincture  of,  133,  302 

compound,  133,  302 
Benzosulphinidum,  266,  285,  302 
Benzoylacetyl  peroxide,  161,  297 
Betaeucaine,  179,  182,  302 
Betanaphthol,  145,  302 
Biborate  of  sodium.     See  Borax. 
Bicarbonate  of  sodium,  118,  321 
Bichloride  of   mercurj^,    150,    233,   293, 

311 
Bisulphide  of  carbon,  305 
Bitter  tonics,  43,  226 
Black  wash,  312 
Black's  "1-2-3"  mixture,  137 
Blaud's  pill,  309 
Bleaching  agents,  38,  159 

action  of,  159 
Blindness  of  infants,  148 
Blistering  agents,  59 
Blisters,  treatment  of,  68 
Blood  serum,  112 
Bloodletting,  general,  57 

local,  56 
Blood-pressure  in  anesthesia,  188 
Blue  mass,  27,  233,  311 

ointment,  233,  311 

piU,  27,  233,  311 

vitriol,  80,  104,  292;  308 
Boracic  acid.     See  Acid,  boric. 
Borate  of  sodium,  120,  126,  286,  297 
Borax.     See  Borate  of  Sodium. 
Boric  acid,  126,  297 
Borine,  144 

Boroglycerin,  glycerite  of,  126,  297 
Borolyptol,  144 
Bougies,  29 
Boulton's  solution,  64 
Bowel,  medication  by,  43 
Brandy,  98,  299 
Bromides,  239,  244,  Plate  XV. 

antagonists  to,  270 
Bromine,  142,  291,  303 
Brow  ague,  227 
Brugg's  mix-ture,  212 
Buchu,  251,  303 

Burnett's  disinfecting  flmd,  82,  296 
Burnt  alum,  80,  103,  299 
Butvlchloral,  305 


Cacao  butter,  29,  323 

Caffeine,  177,  216,  223,  303,  Plate  X. 

antagonists  to,  270 

citrated,  177,  303 
Caffeine-sodium  benzoate,  177,  223,  303 

sahcvlate,  177 
Cajuput,"'oil  of,  137,  140,  316 
Cajuputol,  140 
Calcined  magnes-a,  120,  314 
Calciiim  chloride,  111,  304 

lactate,  HI,  304 
Calomel,  233,  311 
Calumba,  227,  303 
Calx  chlorinata,  142,  160,  303 
Campho-phenique,  78 
Camphor,  221,  292,  304 

spirit  of,  221 
Camphorated  oil,  304 

phenol,  78 
Canker  sores,  76 
Cannabis  indica,  292,  304 
Cantharidal  collodion,  67,  307 

TDls^stGr   67 
Cantharides,  67,  292,  304 

preparations  of,  67,  304 
Capsicum,  61,  304 

tincture  of,  61 
Carbo  animalis,  152,  304 

purificatus,  152,  304 

ligni,  152,  284,  304 
CarboUc  acid,  75,  127,  130,  291 
gangrene,  128 
poisoning,  76,  128,  291 
from  local  use,  77 
Carbon  disulphide,  305 
Carbonic  oxide,  292 
Care  of  mouth  during  pregnane^-,  258 
Caries    in    deciduous    teeth,    nitrite    of 
silver  in,  79 

in  pregnancv,  258 
Carlsbad  salts,  123 
Carron  oil,  68,  90,  303 
Cascara  sagrada,  305,  Plate  XVIII. 
Cassia,  oil  of,  137,  138,  306 
Castor  oil,  27,  245,  316,  Plate  XVIII. 
beans  292 

in  first  dentition,  244,  245 
Cataphoresis,  47,  65 
Cataplasm,  91 
Catechu,  97.     See  Gambir. 
Cathartics,  39,  58,  249,  Plate  XVIII. 
Caustic  alkalies,  73 

lunar,  78,  300 

mitigated,  78,  300 

potash,  74,  295,  318 

pyrozone,  80,  154,  161 

soda,  74,  295,  322       . 
Caustics,  38,  59,  70 
Cautery,  actual,  88 

galvano-,  89 

thermo-,  89 
Cavenne  pepper,  61,  304 
Cerates,  24 


330 


GENERAL  INDEX 


Chalk,  prepared,  121,  284,  303 
Chancre,  236 
Chapped  hands,  92 
Charcoal,  152,  284,  304 
animal,  152,  304 

purified,  152,  304 
Chemical  affinities  of  corrosives,  70 
Chinosol,  135,  156,  305 
Chloral    hydrate,    245,    246,    292,    305, 
Plate  XVI. 
antagonists  to,  269 
phenol,  78 
Chlorate  of  potassium,  145,  295,  318 
Chloride  of  ethyl,  165,  208,  299 

of  zinc,  80,  105,  147,  296,  325 
Chlorinated  lime,  142,  160,  303 
Chlorine,  142,  160,  305 
bleaching  agents,  160 
preparations,  142,  305 
Chloroform  as  anesthetic,  205,  Plate  VII. 
administration,  207 
antagonists  to,  270 
as  anodyne,  206 
as  irritant,  67,  206 
contraindications  to,  195 
dangers  of,  194,  206,  207,  292 
general  uses  of,  206,  306 
history  of,  185 
in  convulsions,  245 
inhaler,  208 
Cholagogues,  Plate  XVIII. 
Chromic  acid,  80,  306 
Chromium  trioxide,  80,  306 
Churchill's  iodine  caustic,  64 

tincture  of  iodine,  64 
Cinchona,  227,  306 
Cinchonine,  32,  306 

iodosulphate,  143,  306 
Cinchonism,  227 
Cineol,  140 

Cinnamic  aldehyde,  138,  139 
Cinnamon,  oil  of,  137,  138,  306 
spirit,  138,  306 
water,  138 
Cloves,  oil  of,  137,  139,  305 
Coagulant  astringents,  96 
Coagulation  of  blood,  agents  that  favor, 

110 
Coal-gas  poisoning,  292 
Cobalt  as  escharotic,  88,  306 
Coca,..169,  306,  Plates  II  and  III. 
Cocaine,  32,  169,  292,  306,  Plates  II  and 
III. 
action  of,  169,  171,  Plates  II  and  III. 
aids  to  action  of,  175 
antagonists  to,  176,  270,  Plate  IV. 
dangers  of,  176 
general  action,  Plates  II  and  III. 

uses  of,  174 
habit,  47,  170,  175 
hydrochloride,  86,  169,  292,  306 
local  action  of,  169,  171 
poisoning,  172,  176,  292 
Schleich  method  of  using,  173 
solutions  of,  168,  173,  267 


Cocaine,  substitutes  for,  178 
comparison  of,  182 
toxicity  of,  182 
Cocainization  of  spinal  cord,  184 
Codeine,  32,  248,  294,  306 
Cod-Uver  oil,  231,  316 
Coffee,  97,  303 
Colchicum,  237,  306 
Cold  as  analgesic,  165 
as  hemostatic,  96 
as  sedative,  238 
Collodion,  24,  114,  307 

cantharidal,  24,  67,  307 
flexible,  24,  114,  307 
styptic,  24,  114,  307 
Columbo.     See  Calumba. 
Coma,  290 

Combinations  of  drugs,  objects  of,  263 
Commercial  preparations,  144 
Common  measure  equivalents,  280,  281 
Compound  solution  of  iodine,  63,  65  313 
spirit  of  ether,  220,  299 
tincture  of  benzoin,  133,  302 
Conductive  anesthesia,  169 
Constituents  of  drugs,  22,  32 
Contraindications,  definition,  20 
to  chloroform,  195 
to  ether,  195 
to  nitrous  oxide,  195 
Convallaria,  307 

Convulsions  during  dentition,  242,  244 
Copperas,  293,  309 
Copper  salts,  poisoning  by,  292 

sulphate,  80,  104,  251,  292,  308 
Corrosive  subUmate,  150,  233,  293,  311 

poisoning,  151,  293 
Corrosives,  70,  290 
Cotarnine,  110,  307 
Cottonseed  oil,  90,  310 
Counterirritants,  59 
degree  of  action,  59 
modes  of  action,  60 
rules  for  applying,  60 
Courtplaster,  25 
CowUng's  rule,  271 
Cream  of  tartar,  51,  250 
Cred(5's  method,  148 
Creolin,  307 
Creosote,  130,  137,  293,  307 

carbonate,  131,  307 
Cresol,  129,  307 
Creta  prsparata,  121,  284,  303 
Croton  oil,  27,  58,  66,  293,  316 
Cubeb,  91,  251,  252,  307 
Cubic  centimeter,  277 
Cumulative  effect,  20 
Cupping,  dry,  55 

wet,  56 
Cupri  sulphas,  80,  104,  251,  292,  308 


Death,  modes  of,  290 
signs  of,  290 


GENERAL  INDEX 


331 


Deciduous  teeth,  phenol  in,  76 

silver  nitrate  in,  79 
Declension  of  nouns  and  adjectives,  274 
Decoctions,  24 

Decolorized  tincture  of  iodine,  66 
Demulcents,  38,  90 
Dentifrices,  283 

Dentine,  sensitiveness  of,  76,  80,  81,  121 
Dentistry  during  pregnancy,  256 
Dentition,  first,  241 

complications  of,  241 
convulsions  during,  242,  244 
lancing  of  gums  in,  56,  243,  246 
Deodorant,  124,  152 
Depletion,  general,  58,  238 
Depletives,  38,  55 

as  sedatives,  238 
Depressants,  238 
Derivative  action,  60 
Detergents,  38,  115 
Devitalizers,  arsenic,  83 

phenol,  76 
Devitalizing  fiber,  86 
Diagnosis,  definition,  20 
Dialyzed  iron,  88,  309 
Diaphoretics,  39,  249,  251 
Digestant,  40 

Digitahs,  177,  224,  250,  308,  Plates  IV  and 
XII. 

antagonists  to,  270 

cumulative  effect  of,  20 
Diluents,  121 

Dioxide  of  hydrogen,   80,    115,    153,    161, 
312 

sodium,  161,  322 

sulphur,  162 
Disinfectant,  124 
Dispensatory,  definition  of,  19 
Dissociation  of  drugs,  52 
Dissolution,  20 
Distilled  oils,  28,  136 
Diuretics,  39,  249,  250 
Diuretin,  251.  324 
Dobell's  solution,  127,  321 
Donovan's  solution,  232,  301 
Dosage  by  rectum,  44 

for  children,  271 

hypodermic,  44 
Doses,  270 

Dover's  powder,  262,  316 
Drastics,  Plate  XVIII. 
Drop  method  for  ether,  204 
Drops  in  flui drachm,  281 
Drug,  definition  of,  18,  21 

habit,  33,  47,  247 
Drugs,  chemical,  21,  70 

classes  of,  21 

constituents  of,  32 

effects  of,  19 

index  of,  297 

modes  of  action  of,  50 

official,  18 

organic,  21^  22 

preparations  of,  22 
Dry  cupping,  55 


E 


Effects  of  drugs,  19,  52 

Elaterin,  30,  293,  308,  Plate  XVIII. 

Elimination  of  drugs,  43 

Eliminatives,  37,  249 

Elixirs,  25 

Emetics,  39,  249,  251 

Emetine,  32,  308 

EmolUents,  38,  91 

Emplastrum,  25 

Emulsin,  228 

Emulsions,  25,  231 

Endermic  method,  44 

Epidermic  method,  44 

Epinephrine,  94,  107,  308 

Epispastics,  38,  59 

Ergot,  108,  308,  Plate  I. 

Errhine,  39 

Erythroxylon  coca,  169 

Escharotics,  38,  59,  70 
mode  of  action,  70 

Esmarch  inhaler,  208 

Ether,  ethyhc,  165,  202,  220,  293,  299 
action  of,  187 
administration  of,  203 
antagonists  to,  270 
as  anesthetic,  203,  Plate  VI. 
as  stimulant,  220 
contraindications  to,  195 
disadvantages  of,  205 
drop  method,  204 
explosiveness  of  vapor,  198 
general  uses  of,  203,  220 
history  of,  185 
inhalers,  204 
spirit  of,  220,  299 

compound,  220,  299 
spray,  165 
nitrous,  spirit  of,  250,  251,  299 

Ethyl  bromide,  212,  308 
chloride,  165,  208,  299 

as  general  anesthetic,  208 
as  local  analgesic,  166 
deaths  from,  209 
inhaler,  209 
safety  of,  208,  211 
spray,  165,  166 

Eucaine.     See  Betaeucaine. 

Eucalyptol,  137,  140,  309 

Eucalyptus,  oil  of,  140,  309 

Eugenol,  137,  139.  309 

Expectorants,  39,  249,  252 

Experiments,  70,  75 

Extracts,  25 
ethereal,  27 
fluid,  25 


Fats,  28 

Ferric  chloride,  tincture  of,  101,  229,  293, 
309 
solution  of,  102,  309 
hydrate.     See  Ferri  hydroxidum. 


332 


GENERAL  INDEX 


Ferri  hydroxidum,  83,  229,  291,  309 

cum  magnesii  oxido,  291,  309 

subsulphas,  liquor,  102,  309 

sulphas,  293,  309 
exsiccatus,  309 

tersulphatis,  liquor,  102,  309 
Ferrous  sulphate,  293,  309 

dried,  309 
Ferrum,  229,  309 
First  dentition.     See  Dentition. 
Flavoring  agents,  285 
Flaxseed,  90,  91,  314 
Fluidextracts,  23,  25 
Formaldehyde,  156,  309 
Formahn,  137,  156,  293,  309 

germicidal  power  of,  137,  144,  157 
Formocresol,  158 
Formulary,  National,  19 
Formulas,  definitions  of,  262 
Foul  breath,  133 
Fowler's  solution,  232,  301 
Frangula,  310,  Plate  XVIII. 
Freezing  mixture,  165 

spray,  165 
Fulminating  silver,  80 
Fungi,  poisoning  by,  293 


Galenical  preparations,  23 

Galla,  97,  310 

GalUc  acid,  97,  108,  310 

Galvanocautery,  89 

Gambir,  97,  310 

Gaultheria,  oil  of,  137,  140,  284,  310 

Gelatin,  111,  310 

General  remedies,  definitions  of,  38 

Gentian,  227,  310 

Germicide,  124 

Gingivitis,  interstitial,  106.  See  Pyorrhea 

alveolaris. 
Glacial  acetic  acid,  73,  297 
Glonoin.     See  Nitroglycerin. 
Ghicosides,  34 
Glycerin,  92,  265,  310 
Glycerite  of  boroglycerin,  126,  297 

of  tannic  acid,  93 
Glycerites,  26 
Glycerol.     See  Glycerin. 
Glycothymoline,  134 
Glycyrrhiza,  91,  310 
Glycyrrhizin,  35,  310 
Gold  and  sodium  chloride,  302 
Gonococcus,  148 
Goulard's  extract,  105,  318 
Gout,  122 
Gram,  277 
Granular  eyelids,  80 
Guaiacol,  131,  307 

carbonate,  131,  307 
Guaiacum,  237,  311 
Gum  arabic,  90,  297 

resins,  29 
Gums,  lancing  of,  56,  243,  246 
Gun  cotton,  24,  319 


H 


Habit,  drug,  33,  47,  247 

Halogens,  142 

Hamamelis,  97,  311 

Heart  during  anesthesia,  194,  206,  212 

massage  of,  214 
Heat  as  counterirritant,  59,  60 

as  hemostatic,  96 

as  stimulant,  221 

sterilization  by,  46,  126 
Hematoxylon,  97 
Hemoglobin  in  anesthesia,  187 
Hemophilia,  57,  111,  112 

calcium  salts  in,  111 
Hemorrhage  after  tooth  extraction,  113 

control  of,  94 

postpartum,  110 
Hemorrhage  diathesis,  57,  111,  112 
Hemostatic  cotton,  102 
Hemostatics,  38,  94 

coagulant,  96,  100 

mechanical,  113 

vascular,  106 
Heroin,  294,  308 
Hexamethylamina,  158,  311 
Hofi"man's  anodyne,  220 
Holocaine  hydrochloride,  311 
Homatropine,  223,  301 
Honey,  315 

Hot  mustard  foot-bath,  62 
Hot-air  bath,  58 
Howard  method  of  artificial  respiration, 

214 
Hydragogues,  58,  Plate  XVIII. 
Hydrargyri   chloridum   corrosivum,    150, 
233,293,311 
mite,  233,  311 

iodidum  flavum,  233,  311 

rubrum,  233,  311 

sahcylas,  233,  237,  312 
Hydrargyrum,  233,  311 

cum  creta,  233,  311 
Hydrastinine,  32,  110,  312 
Hydrochloride  of  cocaine,  86,  169,  292,  306 
Hydrocyanic  acid,  228,  239,  291 
Hydrogen  dioxide    (peroxide),    115,   153, 
161,  312 
caustic,  80,  154,  161,  312 
Hydronaphtol.     See  Betanaphtol. 
Hygienic  remedies,  36 
Hyoscine,  223,  293,  321 
Hyoscyamine,  32,  223,  293,  312 
Myoscyamus,  293,  312 
Hypertonic  solution,  51 
Hypnotics,  39,  246 
Hypodermic  method,  44 

dangers  of,  45 

how  to  employ,  46 

syringe,  46 

sterilization  of,  46 
use  of,  46 

tablets,  31 
Hypodermoclysis,  48,  222 
Hypophosphites,  syrups  of,  231,  312 


GENERAL  INDEX 


333 


H\-popliysis  sicca,  254,  312 
H^'posuTphite  of  sodium,  147,  163,  322 
HjiDotonic  solution,  51 


Ice  and  salt  mLxture,  165 
Idiosj-ncrasy,  53 
Tmmnnity,  54 
Imponderable  remedies,  36 
Incompatibility,  34,  267 

chemical,  267 

intentional,  269 

of  acids,  268 

of  alcohol,  100 

of  alkahes,  268 

of  alkaloids,  34 

of  alum,  103 

of  antip\Tuie,  107,  268 

of  benzoic  acid,  134 

of  betanaphtol,  145 

of  borax,  119,  268 

of  boric  acid,  126 

of  calomel,  268 

of  carbohc  acid,  129,  268 

of  chalk,  121 

of  chlorides,  268 

of  chlorine,  142 

of  cocaine  hydrochloride,  175,  268 

of  collodion,"^114,  268 

of  glucosides,  268 

of  glycerin,  93,  268 

of  gums,  267 

of  iodine,  268 

of  iron  sahs,  102,  268 

of  lead  acetate,  105 

of  hme-Tvater,  120,  268 

of  magnesia,  120 

of  mercuric  chloride,  151,  268 

of  oil  of  turpentine,  63 

of  orthoform,  181 

of  phenol,  129,  268 

of  potassiimi  chlorate,  147,  268 
iodide,  268 
permanganate,  147;  268 

of  resins,  267 

of  resorcui;  145 

of  saUcyhc  acid,  135 

of  silver  nitrate,  80^  268 

of  soap, 118 

of  sodium  bicarbonate,  118 
borate,  119,  268 

of  spirit  of  nitrous  ether,  268 

of  sulphurous  acid,  162 

of  tannic  acid,  97,  268 

of  zinc  chloride,  82 
sulphate,  106 

physical,  267 

therapeutic,  269 
Index  of  drugs,  297 
Indication,  definition  of,  20 
Infusions,  26 

Inhalation,  medication  by,  49 
Inhalers,  204,  208,  210 


Interstitial  gingivitis,  106.    5ee  Pyorrhea 

alveolaris. 
Intravenous  injection,  48 
Iodide  of  potassium,  234,  293,  318 

rash,  237,  note 

of  sodium,  234,  322 
Iodides,  234 
Iodine,  63,  143,  233,  293,  313 

caustic,  64 

compound  solution  of,  63,  65,  313 

ointment  of,  66,  313 

tincture  of,  63,  65,  143,  293,  -313 
ChirrchiU's,  64 
decolorized,  66 
with  aconite,  64,  65 
Iodized  phenol,  78 
Iodoform,  143,  312 

substitutes  for,  143 
lodo-glycerole,  106 
lodol,  143,  312 
Ions,  51 

Ipecacuanha,  91,  251,  252,  313 
Iris  florentina,  284,  313 
Iron,  229,  309 

action  of,  229 

astringent  salts  of,  101 

chloride  of,  101 

tincture  of,  101,  229,  293.  309 

dialyzed,  88,  309 

effect  of,  upon  teeth.  229 

hvdrated  oxide  of,  88,  229,  291.  309 
with  magnesia,  229,291,309 

persulphate  of,  102,  309 

preparations  for  internal  use,  229 

pyrophosphate  of,  229,  309 

subsulphate,  102,  309 

s^Tiip  of  iodide  of,  229,  234,  309 
Irritants,  59,  290 
Isotonic  solution,  51 

of  cocaine,  174 
Itrol,  149,  300 


Jalap,  58,  313,  Plate  XVIII. 
Juniper,  oil  of,  251,  313 


Kixo,  97,  313 
Krameria,  97,  313 


LABARRAQrE's  solutiou,  142,  160,  305 

Laborde  method,  215 

Lactic  acid,  73,  298 

Lancing  of  giuns,  56,  243 

LanoUn,  91,  299 

Lard,  28,  91,  298 

Latin  declensions,  274 

in  prescriptions,  273 
Laudanima,  294,  316 


334 


GENERAL  INDEX 


Laughing  gas  (nitrous  oxide),  199,  315 
Laxatives,  Plate  XVIII. 
Lead  acetate,  104,  293,  318 

and  opium  wash,  105 

salts,  poisoning  by,  104,  293 

water,  105,  3 18 
Leech  glass,  57 
Leeching,  56 
Leiter  coil,  96 
Leucomaines,  34,  289 
Leukocytosis,  53 
Licorice  root,  91,  310 
Lime-water,  119,  303 
Liniments,  26 

Linimentum  calcis,  68,  90,  303 
Linseed,  91    314 

oil,  27,  90 

poultice,  91 
Liquor  acidi  arsenosi,  82,  232,  301 

arseni  et  hydrargyri  iodidi,  232,  301 

calcis,  119,  303 

cresolis  compositus,  129,  307 

ferri  chloridi,  102,309 

subsulphatis,  102,  309 

fonnaldehydi,  137,  156,  293,  309 

hydrogenii  dioxidi,  154 

hypophysis,  254,  312 

iodii  carbolatus,  64 
causticus,  64 
compositus,  65,  3 13 

potassii  hydroxidi,  75,  318 

sodaj  chlorinata-,  142,  160,  305 

sodii  boratis  compositus,  127,  321 
carbolatis,  79,  128,  317 
chloridi  physiologicus,  168,  221 
hydroxidi,  75,322 

zinci  chloridi,  81,  325 
Liquors,  26 
Listerine,  144 
Liter,  277 
Lithemia,  122 
Local  analgesics,  164 

anesthesia,  164 

technique  of,  167 

remedies,  55 

definitions  of,  38 
Logwood,  97 
Losophane,  143,  314 
Lotio  plumbi  et  opii,  105 
Lugol's  solution,  65,  313 
Lunar  caustic,  78,  300 
Lungs,  medication  by,  49 
Lysol,  129,  307 


M 

Magma  magnesise,  120,  291,  314 
Magnesia,  120,  314 

milk  of,  120,  291,  314 
Magnesium  oxide,  120,  314 

sulphate,  314,  Plate  XVIII. 
Massa,  27 

hydrargyri,  27,  233,  311 
Massage  of  heart,  214 


Materia  medica,  definition  of,  18 
Mechanical  hemostatics,  113 
Medicine,  definition  of,  18,  21 
Medicines,  administration  of,  41 

constituents  of,  23,  32 

modes  of  action  of,  50 

preparations  of,  22,  24 
Mel,  285,  315 
Menthol,  141,  315 
Mercurial  ointment,  233,  311 
Mercurialism,  151 

treatment  of,  152 
Mercury,  22,  233,  311 

bichloride  of,  150,  233,  293,  311 

monochloride  of.  233,  311 

oleate  of,  27,  233,  311 

salts,  poisoning  by,  151,  293,  294 

with  chalk,  233,  311 
Meter,  277 

Methyl  salicylate,  140,  315 
Metric  system,  276 

equivalents  of,  276,  278 
rules  for  use  of,  279 
Milk  of  magnesia,  120,  291,  314 
Milliliter,  277,  278 
Mineral  acidS:  71,  229,  291 
antidotes  to,  72 
poisoning  by,  72 

astringents,  100 

waters,  121 
Mitigated  caustic,  78,  300 
Mixtures,  27 
Modes  of  action  of  medicines,  50 

of  death,  290 
Monsel's  salt,  102,  309 

solution,  102,309 
Morphine, 32,  87,  114,246,  248,  294,  315, 
Plate  XVII. 

antagonists  to,  270 

for  children,  247 

habits,  33,  47,  247 
Mouth-washes,  116,  285 

purposes  of,  285 

to  be  antacid,  116 
Mucilages,  27 
Mucous  patches,  236 
Muriatic  acid.     See  Acid,  hydrochloric. 
Mustard  as  emetic,  61,  251,'321 

as  irritant,  61 

bath,  62,  244,  251 

plaster,  62 

volatile  cil  of,  28,  61,  321 
Myrrh,  tincture  of,  132,  315 


N 


Naphtol,  145,  302 
Narcotic,  39 

habit,  47 
National  Formular>%  19 
Nerve  blocking  with  cocain,  170,  note. 
Neutral  principles,  35 
Nicotine,  296,  315 
Nirvanin,  179,  182,  315 


GENERAL  IXDEX 


335 


Nitrate  of  silver,  78,  103,  148,  296,  300. 

Nitre,  250,  295,  319 

Nitrite  of  amvl,  225,  294,  300,  Plate  XIII. 

of  sodium,  225,  322,  Plate  XIII. 
Nitrites,  224,  294,  Plate  XIII. 

antagonists  to,  270 
Nitrogen  monoxide .     iSee  Nitrous  oxide. 
Nitroglycerin,  176,  224,  294,  315,    Plate 
XIII. 
spirit  of,  224,  315 
Nitrous  oxide,  199,  315 

administration  of,  201 

advantages  of,  202 

analgesia,  200 

anesthesia,  200 

contraindications  to,  195 

history'  of,  185 

inhalers,  201 
Normal  salt  solution,  51,  168,  221 
Nose-bleed,  103,  107 
Noims,  declensions  of,  274 
Novocaine,  167^  180 
Nuclein,  68,  note. 
NutgaU,  97,  310 
Nux  vomica,  223,  228,  294,  316,  Plate  XI. 


Objects  of  combining  drugs,  263 

Odol,  144 

Official  drugs,  definition  of,  18 

formulas,  definition  of,  262 
Oil,  carron,  68,  90,  303 

castor,  27,  245,  316,  Plate  XVIII. 

cod-liver,  231,  316 
emulsion  of,  231 

cottonseed,  27,  90,  310 

croton,  66,  203,  316,  Plate  XVIII. 

linseed,  27,  90 

of  bav,  137 

of  bitter  ahnond,  28,  291 

of  cajuput,  137,  140,  316 

of  cassia,  137,  138,  306 

of  cinnamon,  137,  138,  306 

of  cloves,  137,  139,  305 

of  eucalj'ptus,  140,  309 

of  gaultheria,  137,  140,  284,  310 

of  juniper,  251,  313 

of  mustard,  28,  61,  321 

of  peppermint,  137,  141,  221,  315 

of  rose,  285,  320 

of  smoke,  67.  130,  307 

of  theobroma,  29,  323 

of  tiu-pentine,  64,  141,  251,  296,  343 

of  vitriol,  71 

of  wintergreen,  140,  284,  310 

olive,  27,  90,  316 
Oils,  distiUed,  28,  136 

essential,  28,  136 

fixed,  27 
.   volatile,  28,  136 

antiseptic  power  of,  137 
Ointments,  31 
Oleate  of  me^cur^',  27,  233,  311 


Oleates,  27 

Oleoresins,  27 

Opium,  42,  114,  246,  294,  316,  Plate  XVII. 

alkaloids  of,  32,  246 

as  hemostatic,  114 

for  children,  247 

habit,  33,  47,  247 

poisoning,  294 
Organic  acids,  73 
Orpiment,  291 
Orris  root,  284,  313 
Orthoform,  86,  181,  316 

after  extraction  of  tooth,  181 
Osmosis,  51 
Oxalates,  291 
Oxj'gen  bleaching  agents,  161 


Paliiitix,  27 
Pancreatin,  255,  316 
Papaver  somniferum,  246,  316 
Paraformaldehyde,  158,  309 
Paregoric,  247,  294,  316 
Paris  green,  291 

Peck,  A.  H.,  experiments  with  antisep- 
tics, 136,  137 
Peppermint,  oil  of,  137,  141,  221,  315 
Pepsin,  255,  317 
Per  chloride  of  mercur\%  150 
Pericementitis,  counterirritants  in,  61,  62 

hot  mustard  foot-bath  in,  63 

iodine  in,  64 

morphine  in,  247 
Permanganate  of  potassiimi,  146,  162,  314 
Peroxide  of  hydrogen,  115,  153,  161,  312 

of  sodium,  161 
Persulphate  of  iron,  102 
Petrolatum,  28.  90,  317 

hquidum,  90 
Phagoc\'tosis,  54 
Pharmacolog\",  definition  of.  18 
Pharmacopoeia,  U.  S.,  18,  24,  263 
Pharmacy,  definition  of,  IS 
Phar\Tigitis,  chronic,  103 
Phenacetine,  240,  297 
Phenazone,  107.  300 
Phenol,  75,  127,  130    291,  317 

coefficient,  124,  note. 

germicidal  power  of,  128,  137 

liquefied,  75,  127 

poisoning,  76,  128.  291 

sodique,  128.  317 
Phenolphthalein,  317,  Plate  XVIII. 
Phenyl  saKcylas,  135,  317 
Phlebotomv,  57 

Phosphoric  acid,  dilute,  231,  298 
Phosphorus,  230.  295,  317 
Ph^'sical  action  of  medicines,  50 
Physiologic  action,  19 
"  antidote,  269 

effect,  19 

salt  solution,  51,  168,  241 
Pills,  28 


336 


GENERAL  INDEX 


318, 


Pilocarpine,  32,  251,  317 
Pituitarj'  body,  254,  312 
Plasters,  25 

Plumbi  acetas,  104,  293,  318 
Podophyllum,  318,  Plate  XVIII. 
Poisons,  21,  289 
table  of,  291 
Potash,  caustic,  74,  295,  318 
Potassa,  74,  295 
Potassium  acetate,  250,  318 
and    sodium    tartrate, 

XVIII. 
bitartrate,  51,  250,  295,  318, 

XVIII. 
bromide,  239,  Plate  XV. 
chlorate,  145,  295,  318 

in  mercurialism,  146,  152 
citrate,  250,  318 
cvanide,  78,  293,  318 
hydroxide,  74,  295,  318 
iodide,  65,  234,  293,  318 
in  mercurialism,  152 
nitrate,  2.50,  295,  319 
permanganate,  146,  162,  314 
as  antidote,  147,  294,  295 
to  remove  stains  of,  146 
sulphate,  295,  319 
Poultice,  91 

Pregnancy,  dentistrv'  during,  256 
care  of  the  mouth  during,  258 
caries  during,  258 
Preparations  of  drugs,  22 
classes  of,  24 
galenical,  23 
Prepared  chalk,  121,  284,  303 
Prescription,  construction  of,  283 
definition  of,  262 
parts  of,  271 
use  of  Latin  in,  273 
writing,  261 
Proof  spirit,  98 
Proprietary'  solutions,  144 
Protargol, '149,  319 
Proud  flesh,  69,  80 
Proximate  principles  of  drugs,  22,  32, 
Prunus  Virginiana,  228,  239,  319 
Ptomaines,  34,  289 
Ptyalagogue,  39 

Pulp,  devitalization  of,  76,  83,  88 
Pulpitis,  64,  76 
Pulse  during  anesthesia,  194 
Pulvis  acetanilidi  compositus,  240 
ipecacuanhjB  et  opii,  262,  316 
Pumice,  powdered,  284 
Pumpkin  seed,  317 
Pupils  during  anesthesia,  192,  194 
Purges,  Plate  XVIII. 
Pyorrhea  alveolaris,  73,  80,  81,  138, 
PyroxTlinum,  114,  319 


QuA-ssiA,  227,  319 
Quicksilver,  233,  311 


Quinine,  32,  227,  319 

and  urea  hvdrochloride,  181,  319 

sulphate,  155,  227,  319 
Quinosol,  135,  156,  305 


R 


Reactionary  effects  of  drugs,  53 
Realgar,  291 
Plate    I^sctmn,  medication  by,  43 

Reducing  agents ,  162 
Plate    Remedies,  36 

general,  37,  185 

hygienic,  36 

imponderable,  36 

local,  37,  55 

mechanical,  36 

medicinal,  36 

preventive,  36 
Remedy,  definition  of,  21,  36 
Resins,  28 

balsamic,  29 

gum,  29 
Resorcin,  145,  319 
Respiration,  artificial,  178,  213,  214 
methods  of,  213-215 

during  anesthesia,  191,  193,  212 
Restorative  tonics,  228 
Re^allsive  action,  60 
Rhatany,  97,  313 
Rhigolene  sprav,  165 
Rhubarb,  320,  Plate  XVIII. 
Ringer's  solution,  168 
Rochelle  salt,  318,  Plate  XVIII. 
Rose,  oil  of,  285,  320 
Rosin,  62 
Rubefacients,  38,  59 


Saccharine,  285,  302 
Saccharum,  264,  320 

lactis,  31,  320 
note.    Salicj'late  of  mercurv,  233,  237,  312 

of  phenvl,  135,  317 

of  sodium,  135,  322 
Salicylic  acid,  134,  286,  298 
Saline  cathartics,  58,  Plate  XVIII. 

solution,  48,  168,  221 
Salivation,  151 

treatment  of,  152 
Salol,  135,  317 
Salt  action,  51 

solution,  normal,  48,  168,  221 
Saltpetre,  250,  295,  319 
Santonin,  35,  320 
145     Sapo,  29,  117,  284,  320 

moUis,  29,  117,  320 
Sarsaparilla,  237,  320 
Scarification,  56 
Schleich  method,  173 

mixtures,  212 
Scilla,  250,  2.52,  321 
Scopolamine  hydrobromide,  223,  293, 321 


GENERAL  IXDEX 


337 


•  SeurT\',  230 
Sedatives,  37,  39,  238 

for  children,  238,  247 
Seidlitz  powder,  318 
Seller's  solution,  144 
Senna,  321,  Plate  XVIII. 
Sensitive  dentine,  76,  81,  121 
Serum  antidiphthericum,  254,  321 

antitetanicum,  255,  321 
Sialagogue,  39,  91 
Silver  citrate.  149,  300 

lactate,  149,  300 

nitrate,  78,  103,  148,  296,  30O 
removal  of  stain  of,  78 
to  check  caries,  79 

soluble,  148 
Sinapis,  61,  251,  321 
Sinapism,  62 
Sinigrin,  61 
Skin  grafting,  69 
SUpper^-  ehn.  90,  324 
Soap,  castile,'  29,  117,  284,  320 

soft,  29,  117,  320 
Soaps,  29,  117,  320 
Soda,  caustic,  74,  295 
Sodium  bicarbonate,  118,  321 

bisulphite,  162,  298 

borate,  118.  126,  286,  321 

bromide,  239,  322,  Plate  XY. 

chloride,  48,  221.  322 
as  emetic,  251 

diborate.     See  Sodiimi  borate. 

dioxide,  161,  322 

hvdroxide,  74,  295.  322 

h^TJosulphite,  147,  163.  322 

iodide,  234,  322 

nitrite,  225,  322,  Plate  XIII. 

perborate,  127.  322 

salicvlate,  135,  322 

sulphate,  322.  Plate  XYIII. 

sulphite.  162.  298 

thiosulphate.  147,  160.  163,  322 
Solubihties,  264,  265 
Solutions,  26 

percentage,  265 

table  for  preparing,  266 

saturated,  265 
Solvents,  265 
Sonmoform.  210.  212 

deaths  from,  210 
Sozoiodol,  143,  322 
Spanish  flies.  67,  304 
Spermaceti,  28,  305 
Spinal  cocainization,  184 
Spirit  of  ammonia,  220 

aromatic,  178,  216.  220,  300 

of  ether,  220,  299 

compound,  220,  299 

of  nitrous  ether,  250,  251,  299 
Spirits,  2£r 
Spiritus  aetheris  nitrosi,  250,  251,  299 

frumenti.  98,  299 

\Tni  gallici,  98,  299 
rectificatus,  216 
Spirocheta  paUida,  236 


Squill.  250.  2.52,  321 
Standardization  of  drugs,  23 
Stenson's  duct,  56 
Sterilization,  46.  126 
StemutatorA-.  39 
Stimulants. *37,  217 

definition  of,  38,  217 

diffusible,  219 

direct,  217 

for  children,  218 

indication  for,  218 

indirect,  218  ' 

irritant,  219 

kinetic,  217 

potential,  217 

reflex,  219 
Stomach  administration,  41 
Stomatitis.  127,  146,  152 
Stovaine.  181 
Stramonium.  296,  322 
Strophanthuls.  224,  250,  323 
St^^-chnine,    177,    216,    223.    294.    323, 
Plates  lY  and  XI. 

antagonists  to.  270 
Styptic  coUodion,  24.  114.  307 
Stypticin.  110 
Styptics,  94,  106 
Substitutes  for  cocaiae.  178 
Sudorifics.  39,  251 
Sugar,  30.  264.  320 

of  lead,  104,  293,  318 

of  mUk,  30,320 
Sulphate  of  copper.  SO.  104,  251,  292.  308 

of  zinc.  105.  251.  296.  325 
Sulphonal.  246.  323 
Sulphonethyhnethane,  246,  323 
Sulphonmethane,  323.  246 
Sulphur,  323 

dioxide.  162 
Sulphuric  ether.     See  Ether. 
Stilphtirous  acid.  162,  298 
Suppositories,  29 

glycerin.  29 
Suprarenal  glands.  107,  253,  323 
Suprarenalum  sicciun,  107,  253,  323 
Sweating  bj'  hot-air  bath,  58 

bv  drugs,  251 
Sweet'spirit  of  nitre,  250,  251,  299 
Svlvester  method  of  artificial  respiration, 

"213,  214 
S\-ncope.  290 

during  anesthesia,  194 
Synthetics.  22.  240 
SjTtilis,  20,  234 

catise  of,  236 

curability  of,  237 

mercmy  in.  236 

salvarsan  in.  236 

self-infection  by.  235 

s\Tnptoms  of.  236 

treatment  of,  234-237 
Sj'ringe  for  local  anesthesia,  168 
SjTups,  30 

of  h^-pophosphites.  231.  312 

of  iodide  of  iron,  229,  234,  309 


338 


GENERAL   IXDEX 


Table  for  preparing  percentage  solutions, 
266 

of  poisons  and  antidotes,  291 
Tablet  triturates.  31 
Tablets,  compressed,  31 

h\'podermic,  31 
Tannic  acid,  33,  96,  298 
glycerite  of,  93 
Tartar  emetic,  251,  300 
Tea,  97 

Terebene,  141,  323 
Theobroma,  323 

oil  of,  323 
Theobromine,  223,  251,  324 

sodium  salicylate,  251,  324 
Therapeutics,  definition  of,  18 
Thermocau  ter\',  S9 
Thimble  bUster,  6S,  206 
Thiosulphate  of  sodiimi,  147.  100.  163,  322 
Th^-mol.  140,  324 

iodide.  141.  324 
Th}Toid  gland   112.  253.  324 
Th^Toideum  siccum,  112.  253,  324 
Tincture  of  aconite.  64.  65,  243,  291,  298 

of  benzoin.  133.  302 

of  capsiciun.  61,  304 

of  chloride  of  iron,  101    229,  293,  309 

of  m^Trh,  132,  315 
Tinctures,  23,  30 
Tobacco,  296 

Tolerance  for  drugs.  20,  247 
Tonics.  39.  226 

bitter.  226.  227 

nutritional.  226 

restorative  226.  228 
Tooth  paste.  285 

powders,  283 
Toothache,  62,  64.  76.  206.  247 
Toxic  effect  of  a  drug,  19 
Toxicity  of  anesthetics,  210 
Toxicology-,  18,  289 
Trichloracetic  acid.  73,  298 
Trichlorphenol,  129 
Tricresol,  129 
Trional,  246,  323 
Triturates,  30 
Troches,  31 

Tropacocaine  hydrochloride,  181,  183,  324 
Turpentine  liniment,  26.  63 

oil  of,  62.  141,251,  296,  323 

stupe,  63 


Vaccixatiox.  36,  54 
Vaccines.  40.  54 
Vascular  astringents.  106 
Vaseline,  28,  91,  317 
^'asodilato^s,  225 
Vegetable  acids,  230 

alteratives,  237 

astringents,  97 
Venesection,  57 
Venom.  289 
Veratrine,  32,  324 
Veratrum,  110.  239.  324 
Verdigris,  292 
Vermifuge.  40 
Vesicants,  38,  59 
Vienna  paste,  318 
Vinegars.  24 
Vinum.  324,  325 
Virus.  289 
Vitriol,  blue.  80 

oil  of.  71 

white.  105 
Volatile  oils,  28,  136 

comparative  action  of.  136.  137 


W 


Wadsworth,  comparison  of  antiseptics, 

144 
Warts,  nitric  acid  applied  to.  71 
Wassermann  test.  237 
Waters,  medicated,  24 

mineral.  123 
Wax,  28,  305 
Weeping  gums,  73 
Wet  cupping,  56 
Weights  and  measures,  275 
\Miisky,  98,  299 
\Miite\-itriol.  105 
Whooping-cough.  145 
Wild  cherry,  22S,  239,  319 
Wines,  red.  325 

white.  324 
Witch-hazel.  97.  311 
Wood  alcohol.  100.  299 

charcoal.  152.  304 

spirit.  100,  299 

blindness  from,  100 


U 


Ulmfs,  90.  324 
Unguentum,  31 

hydrarg>Ti.  233.  311 
United  States  Pharmacopoeia,  24,  263 
Untoward  effects  of  drugs,  19,  53 
Uric  acid,  122 
Urotropin,  158.  211 
Uva  ursi,  251,  324 


Yeast,  brewers',  68 
Yellow  wash,  312 


Zixc  chloride.  80.  105.  147.  296.  325 
iodide.  106.  325 
oxide,  106.  325 
sulphate,  105,  251,  296,  325 


